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Long-term prognostic value of endothelial dysfunction in patients with chest pain and angiographically normal

Angel Sánchez-Recalde1, Guillermo Galeote, Raúl Moreno

  • 1Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain. asanchezr.hulp@salud.madrid.org

Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology
|November 10, 2009
PubMed

Insights

Endothelial dysfunction in patients with angina and normal coronary arteries predicts future cardiovascular events, primarily worsening angina requiring hospitalization. This simple test identifies high-risk individuals for closer monitoring.

Area of Science:

  • Cardiovascular Medicine
  • Clinical Cardiology
  • Vascular Biology

Background:

  • Angina pectoris with normal coronary arteries on angiography affects a significant patient population.
  • The prognostic value of endothelial function in this specific group remains incompletely understood.
  • Identifying individuals at higher risk for adverse cardiovascular events is crucial for guiding management.

Purpose of the Study:

  • To determine the prognostic significance of endothelial dysfunction in patients presenting with angina and angiographically normal coronary arteries.
  • To assess whether endothelial function can predict long-term cardiovascular outcomes in this cohort.

Main Methods:

  • 147 patients with angina and normal coronary arteries underwent endothelial function assessment using incremental intracoronary acetylcholine (ACh) bolus.
  • Patients were categorized into two groups: ACh+ (diffuse vasoconstriction, n=95) and ACh- (normal function, n=52).
  • Cardiovascular events (unstable angina admissions, myocardial infarction, revascularization, stroke, cardiac death) were tracked over a 7-year follow-up.

Main Results:

  • 33 patients (22%) experienced cardiac events, with significantly more in the ACh+ group (29 vs. 4, p=0.002).
  • Endothelial dysfunction (ACh+ group) was independently associated with a higher incidence of cardiovascular events after adjusting for risk factors.
  • Excluding unstable angina admissions, endothelial dysfunction remained a predictor, though the difference in major events was not statistically significant (p=0.2).

Conclusions:

  • Endothelial function testing in patients with angina and normal coronary arteries can identify a subgroup at high risk for future cardiovascular events.
  • Worsening angina leading to hospital readmission is the primary event associated with endothelial dysfunction in this population.
  • This simple test offers valuable prognostic information for long-term patient management.
Abstract

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