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Contribution of Age-Related Microvascular Dysfunction to Abnormal Coronary: Hemodynamics in Patients With Ischemic
Tim P van de Hoef1, Mauro Echavarria-Pinto2, Martijn Meuwissen3
1Amsterdam UMC, University of Amsterdam, Heart Center, Department of Interventional Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Cardiovascular Institute, Hospital Clínico San Carlos, and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
Insights
Aging worsens coronary microvascular function, increasing the risk of ischemic heart disease. This age-related decline in coronary flow reserve is not fully captured by pressure measurements alone.
Area of Science:
- Cardiovascular physiology
- Geriatric cardiology
- Vascular biology
Background:
- Coronary atherosclerosis impairs myocardial blood supply.
- Age-related microcirculatory changes can exacerbate this impairment.
Purpose of the Study:
- To investigate how age-related microcirculatory dysfunction contributes to abnormal coronary hemodynamics in patients with coronary atherosclerosis.
- To analyze the association of aging with coronary hemodynamics in both unobstructed and stenosed arteries.
Main Methods:
- Intracoronary pressure and flow were measured using Doppler and thermodilution techniques in 228 patients (299 vessels) and 99 patients (120 vessels), respectively.
- Doppler measurements were also performed in unobstructed vessels in 172 patients.
- Coronary hemodynamics were assessed in relation to age in both stenosed and unobstructed coronary arteries.
Main Results:
- Advancing age correlated with increased minimal microvascular resistance and decreased hyperemic flow in all coronary arteries, leading to reduced coronary flow reserve.
- Fractional flow reserve increased with age, while epicardial stenosis severity remained consistent across age groups.
- The risk of combined epicardial and microvascular disease patterns increased with age, whereas the risk of non-flow-limiting stenosis with healthy microcirculation decreased.
Conclusions:
- Aging progressively impairs coronary vasodilatory capacity due to increased minimal microvascular resistance.
- Age-related microvascular dysfunction is a key factor in ischemic heart disease pathophysiology.
- Hyperemic coronary pressure measurements alone may not adequately identify aging-related microvascular impairment.
Objectives:
This study sought to investigate the contribution of age-related microcirculatory dysfunction to abnormal coronary hemodynamics in patients with coronary atherosclerosis.
Background:
Impairment in myocardial blood supply in patients with coronary atherosclerosis can be accentuated due to age-related changes in microcirculatory function.
Methods:
Intracoronary pressure and flow were measured with the Doppler technique in 299 vessels (228 patients), and the thermodilution technique in 120 vessels (99 patients). In 172 patients, Doppler measurements were also performed in unobstructed vessels. Associations of coronary hemodynamics with aging were studied in both the stenosed and unobstructed arteries.
Results:
Aging was associated with a progressive increase in minimal microvascular resistance and a progressive decrease in hyperemic flow in both obstructed and nonobstructed coronary arteries. As such, coronary flow reserve decreased with advancing age. Epicardial stenosis severity assessed by resting Pd/Pa, basal stenosis resistance index, and hyperemic stenosis resistance index was equivalent across age groups. By contrast, fractional flow reserve increased with advancing age. Consequently, the adjusted risk of a fractional flow reserve/coronary flow reserve pattern reflective of concomitant focal epicardial and diffuse or microvascular disease (relative risk: 1.6; 95% confidence interval: 1.1 to 2.3; p = 0.017) increased with advancing age, whilst the adjusted risk of a fractional flow reserve/coronary flow reserve pattern reflective of non-flow-limiting stenosis with a healthy microcirculation decreased (relative risk: 0.7; 95% CI: 0.5 to 1.0; p = 0.022).
Conclusions:
Aging is associated with progressive pan-myocardial impairment of coronary vasodilatory capacity due to an increase in minimal microvascular resistance. Concomitant aging-related impairment in microvascular function impacts the pathophysiology of ischemic heart disease in the individual patient and is not adequately identified by hyperemic coronary pressure measurements alone.
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