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Epicardial and microvascular coronary vasomotor dysfunction and its relation to myocardial ischemic burden in

Edoardo Verna1, Sergio Ghiringhelli2, Stefano Provasoli2

  • 1Department of Cardiology, Ospedale di Circolo & Fondazione Macchi, University Hospital-Varese, Università dell'Insubria, Viale Borri 57, 21100, Varese, Italy. edoardo.verna@virgilio.it.

Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
|April 5, 2017
PubMed

Insights

Epicardial endothelium-dependent dysfunction (EDD) significantly increases myocardial ischemia extent in non-obstructive coronary artery disease (NOCAD) patients. Assessing both EDD and microvascular endothelium-independent dysfunction (EIMVD) is crucial for identifying patients with greater ischemic burden.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Diagnostic Imaging

Background:

  • Non-obstructive coronary artery disease (NOCAD) presents diagnostic challenges for myocardial ischemia.
  • Coronary vasomotor dysfunction, encompassing epicardial and microvascular components, is increasingly recognized in NOCAD.
  • Understanding the distinct contributions of different types of coronary vasomotor dysfunction is essential for accurate ischemia assessment.

Purpose of the Study:

  • To evaluate the differential impact of epicardial endothelium-dependent dysfunction (EDD) and microvascular endothelium-independent dysfunction (EIMVD) on myocardial ischemia extent.
  • To determine the relative contribution of EDD versus EIMVD in patients with NOCAD and ischemic symptoms.

Main Methods:

  • Quantitative angiography and coronary blood flow (CBF) measurements using acetylcholine, nitroglycerine, and adenosine.
  • Myocardial SPECT imaging to assess ischemic burden via summed stress (SSS) and summed ischemic (SDS) perfusion defect size.
  • Analysis of vasomotion in 101 patients with suspected coronary artery disease and normal or non-obstructive coronary angiography.

Main Results:

  • Coronary vasomotor dysfunction was prevalent (77%), with divergent EDD and EIMVD patterns in over half of affected patients.
  • Epicardial endothelium-dependent dysfunction (EDD) was significantly associated with a greater myocardial ischemic burden (higher SDS and SSS) compared to EIMVD or normal vasomotion.
  • Reduced acetylcholine-induced CBF correlated strongly with increased SDS and SSS, indicating functional impairment.

Conclusions:

  • Vasomotor dysfunction is common in NOCAD patients presenting with ischemia.
  • Epicardial endothelium-dependent dysfunction (EDD) is a more significant driver of myocardial ischemia extent than isolated microvascular endothelium-independent dysfunction (EIMVD).
  • Comprehensive assessment of both EIMVD and EDD is necessary to elucidate ischemia mechanisms and identify patients at higher risk.
Abstract

Keywords:
Coronary artery diseaseCoronary blood flowEndothelial dysfunctionMicrovascular diseaseMyocardial perfusion imaging (SPECT)

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