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Published on: August 17, 2022
Coronary microvascular dysfunction due to essential thrombocythemia and policythemia vera: the missing piece in the
Fabrizio Vianello1, Giuseppe Cella, Elena Osto
1Department of Medicine DIMED, University Hospital, Padua, Italy.
Insights
Patients with essential thrombocythemia (ET) and polycythemia vera (PV) exhibit impaired coronary microvascular function, indicated by lower coronary flow reserve (CFR). This suggests a higher risk for coronary artery disease (CAD) even without symptoms.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Medical Diagnostics
Background:
- Myeloproliferative neoplasms, including essential thrombocythemia (ET) and polycythemia vera (PV), are linked to a high incidence of venous thrombosis.
- The association between ET and PV and the risk of coronary artery disease (CAD) remains unclear, despite shared pathogenetic factors with other thrombotic complications.
- Coronary microvascular function, assessed by coronary flow reserve (CFR), is a crucial indicator of cardiovascular health.
Purpose of the Study:
- To evaluate coronary flow reserve (CFR) as a marker of coronary microvascular function in asymptomatic patients diagnosed with ET and PV.
- To determine if ET and PV patients, despite lacking clinical signs of heart disease, exhibit signs of coronary microvascular dysfunction.
- To investigate the potential link between JAK2 gene mutation and abnormal CFR in these patient groups.
Main Methods:
- Transthoracic Doppler echocardiography was employed to measure CFR in the left anterior descending coronary artery.
- Measurements were taken at rest and during adenosine-induced hyperemia in 52 ET patients, 22 PV patients, and 50 age- and gender-matched controls.
- Patients with existing CAD or clinical heart disease were excluded from the study.
Main Results:
- Asymptomatic ET and PV patients demonstrated significantly lower CFR compared to controls (ET: 2.9±0.94, PV: 2.2±0.7 vs. Controls: 3.8±0.7).
- A higher prevalence of CFR ≤ 2.5 was observed in ET (38.5%) and PV (68.2%) patients compared to controls (4.1%).
- Severe CFR impairment (CFR < 2) was present in 15.4% of ET patients and 40.9% of PV patients, with none in the control group. JAK2 mutation correlated with abnormal CFR.
Conclusions:
- Asymptomatic patients with essential thrombocythemia (ET) and polycythemia vera (PV) exhibit coronary microvascular dysfunction.
- Coronary microvascular dysfunction, indicated by reduced CFR, is present in ET and PV patients even in the absence of overt coronary artery disease (CAD).
- These findings highlight the importance of assessing microvascular function in ET and PV patients to identify individuals at increased risk for cardiovascular events.
Abstract:
Myeloproliferative neoplasms are most commonly associated with venous thrombosis. Up to 60% of patients experience a thrombotic event in their lifetimes, including stroke or myocardial infarction. It is unclear whether pathogenetic factors linking essential thrombocythemia (ET) and polycythemia vera (PV) to thrombotic complications do play a role in the risk of coronary artery disease (CAD). We aimed to assess coronary flow reserve (CFR) as a marker of coronary microvascular function in asymptomatic patients with ET and PV. Fifty-two patients with ET (M/F 13/39, age 61 ± 7 years) and 22 patients with PV (M/F 13/9, age 60.4 ± 13 years) without clinical evidence of heart disease, and 50 controls matched for age and gender were studied. None had CAD. All control subjects were asymptomatic with no history of heart disease. CFR in the left anterior descending coronary artery was detected by transthoracic Doppler echocardiography, at rest, and during adenosine infusion. In patients with ET and PV, CFR was lower than in controls (2.9 ± 0.94 and 2.2 ± 0.7 vs. 3.8 ± 0.7, P < 0.004 and P < 0.0001 respectively). The prevalence of CFR ≤ 2.5 was higher in patients with ET (20 cases, 38.5%) and PV (15 cases, 68.2%) compared with controls (4.1%) (P < 0.0001). Severe CFR (CFR < 2) impairment was found in eight patients with ET (15.4%), in nine patients with PV (40.9%), and in none of control subjects. The mutation of JAK2 gene was associated with abnormal CFR. Asymptomatic patients with ET and PV have coronary microvascular dysfunction in the absence of clinical conditions suggesting CAD.
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