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Non-invasive assessment of endothelial function in patients with spontaneous coronary artery dissection: A
Ricardo Mori1, Fernando Macaya1, Jaskanwal D Sara2
1Hospital Clínico San Carlos, IdISSC and Universidad Complutense, Madrid, Spain.
Insights
Patients with spontaneous coronary artery dissection (SCAD) exhibit poorer endothelial function compared to individuals without SCAD. This suggests endothelial dysfunction may play a role in SCAD
Area of Science:
- Cardiology
- Vascular Biology
- Endothelial Function
Background:
- Spontaneous coronary artery dissection (SCAD) physiopathology is poorly understood.
- Endothelial dysfunction is an early indicator in various vascular disorders.
- Investigating endothelial function in SCAD patients is crucial.
Purpose of the Study:
- To assess endothelial function in SCAD patients using reactive hyperemia peripheral arterial tonometry (RH-PAT).
- To compare endothelial function between SCAD patients and matched controls with similar cardiovascular risk profiles.
Main Methods:
- A case-control study involving 23 SCAD patients and 46 matched controls.
- Endothelial function was measured using the log-transformed reactive hyperemia index (LnRH-PAT).
- Patients were matched based on cardiovascular risk factors.
Main Results:
- SCAD patients (mean age 52.7 years, 95.7% female) showed significantly poorer endothelial function (mean LnRH-PAT 0.55 ± 0.22) compared to controls (0.77 ± 0.23).
- Higher prevalence of migraine, beta-blocker, ACE inhibitor, and statin use was observed in the SCAD group.
- The difference in LnRH-PAT between groups was statistically significant (p < 0.001).
Conclusions:
- SCAD patients demonstrate impaired endothelial function compared to non-SCAD individuals.
- This finding suggests a potential role for endothelial dysfunction in SCAD pathophysiology.
- Further research into the underlying mechanisms of SCAD is warranted.
Background:
The physiopathology underlying spontaneous coronary artery dissection remains largely unknown. Endothelial dysfunction is an early feature of many vascular disorders. We sought to determine the endothelial function assessed by reactive hyperemia peripheral arterial tonometry (RH-PAT) in patients with SCAD and compare it to that of non-SCAD patients with similar cardiovascular risk profile.
Methods:
This is a case-control study with the participation of 2 centers. Patients (cases) were diagnosed with SCAD between 2008 and 2018. Control subjects were individually matched 2:1 to SCAD cases from a cohort recruited for assessment with RH-PAT between 2006 and 2013. The primary measure variable was the mean difference in the log-transformed reactive hyperemia index (LnRH-PAT Index) between groups.
Results:
LnRH-PAT data from 23 patients with SCAD and 46 matched controls were analyzed. No significant differences were noted in the matching variables (overall, 95.7% female with mean age 52.7 years). In the SCAD group, more patients reported migraine (61 vs. 21%) and more patients were on betablockers (70 vs 28%), ACE inhibitors (65 vs. 13%) and statins (70 vs. 28%), all differences statistically significant. The mean LnRH-PAT value was 0.55 ± 0.22 in patients with SCAD and 0.77 ± 0.23 in controls (mean difference: 0.22, p < 0.001).
Conclusions:
In this observational study, patients with SCAD had a poorer endothelial function than similar subjects without prior SCAD. This finding opens a new venue in the research of the physio pathologic mechanisms underlying SCAD.
