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Local coronary wall eccentricity and endothelial function are closely related in patients with atherosclerotic
Allison G Hays1, Micaela Iantorno2, Michael Schär3
1Department of Medicine, Division of Cardiology, Johns Hopkins University, 600 N Wolfe St., Baltimore, MD, 21287, USA. ahays2@jhmi.edu.
Insights
Coronary artery disease patients show a strong link between reduced coronary endothelial function and increased coronary artery wall eccentricity. This finding helps identify high-risk patients and lesions noninvasively.
Area of Science:
- Cardiovascular Imaging
- Medical Diagnostics
- Vascular Biology
Background:
- Coronary endothelial function (CEF) varies within individuals with coronary artery disease (CAD).
- Both coronary vessel wall eccentricity and endothelial dysfunction predict adverse outcomes.
- This study hypothesized a link between local endothelial dysfunction and local coronary artery eccentricity.
Purpose of the Study:
- To investigate the relationship between coronary artery eccentricity and endothelial function in patients with CAD.
- To determine if coronary artery eccentricity is an independent predictor of endothelial dysfunction.
Main Methods:
- Used 3 Tesla (3T) coronary cardiac magnetic resonance (CMR) to assess CEF via changes in coronary cross-sectional area (CSA) and coronary blood flow (CBF) during isometric handgrip exercise (IHE).
- Quantified coronary wall thickness (CWT) and coronary eccentricity index (EI) using black-blood MRI in the same coronary segments.
- Evaluated 29 CAD patients and 16 healthy controls.
Main Results:
- CAD patients exhibited significantly impaired IHE-induced changes in CSA and CBF compared to healthy subjects.
- CAD patients had greater mean CWT and EI than healthy individuals.
- A significant inverse relationship was found between stress-induced %CSA change and both EI (r=-0.60, p=0.0002) and CWT (r=-0.54, p=0.001) in CAD patients.
- Coronary EI independently predicted %CSA change during IHE (adjusted r=-0.69, p=0.0001).
Conclusions:
- A significant, independent inverse relationship exists between coronary endothelial macrovascular function and local coronary wall eccentricity in CAD patients.
- Anatomic (eccentricity) and physiologic (endothelial dysfunction) markers of high-risk coronary pathology are closely related.
- Noninvasive assessment of coronary eccentricity may help identify high-risk patients and culprit lesions by reflecting underlying endothelial function.
Background:
Coronary endothelial function (CEF) in patients with coronary artery disease (CAD) varies among coronary segments in a given patient. Because both coronary vessel wall eccentricity and coronary endothelial dysfunction are predictors of adverse outcomes, we hypothesized that local coronary endothelial dysfunction is associated with local coronary artery eccentricity.
Methods:
We used 3 T coronary CMR to measure CEF as changes in coronary cross-sectional area (CSA) and coronary blood flow (CBF) during isometric handgrip exercise (IHE), a known endothelial-dependent stressor, in 29 patients with known CAD and 16 healthy subjects. Black-blood MRI quantified mean coronary wall thickness (CWT) and coronary eccentricity index (EI) and CEF was determined in the same segments.
Results:
IHE-induced changes in CSA and CBF in healthy subjects (10.6 ± 6.6% and 38.3 ± 29%, respectively) were greater than in CAD patients 1.3 ± 7.7% and 6.5 ± 19.6%, respectively, p < 0.001 vs. healthy for both measures), as expected. Mean CWT and EI in healthy subjects (1.1 ± 0.3 mm 1.9 ± 0.5, respectively) were less than those in CAD patients (1.6 ± 0.4 mm, p < 0.0001; and 2.6 ± 0.6, p = 0.006 vs. healthy). In CAD patients, we observed a significant inverse relationship between stress-induced %CSA change and both EI (r = -0.60, p = 0.0002), and CWT (r = -0.54, p = 0.001). Coronary EI was independently and significantly related to %CSA change with IHE even after controlling for mean CWT (adjusted r = -0.69, p = 0.0001). For every unit increase in EI, coronary CSA during IHE is expected to change by -6.7 ± 9.4% (95% confidence interval: -10.3 to -3.0, p = 0.001).
Conclusion:
There is a significant inverse and independent relationship between coronary endothelial macrovascular function and the degree of local coronary wall eccentricity in CAD patients. Thus anatomic and physiologic indicators of high-risk coronary vascular pathology are closely related. The noninvasive identification of coronary eccentricity and its relationship with underlying coronary endothelial function, a marker of vascular health, may be useful in identifying high-risk patients and culprit lesions.
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