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Published on: August 17, 2022
Endothelial dysfunction and inflammation in patients with non-obstructive coronary arteries
N N Pakhtusov1, A O Iusupova1, E V Privalova1
1I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
Insights
Patients with non-obstructive coronary artery disease show higher endothelin-1 levels and endothelial dysfunction, suggesting a role in ischemic heart disease (IHD) pathogenesis. Tumor necrosis factor-alpha was not a useful marker in this study.
Area of Science:
- Cardiovascular Medicine
- Biomarkers
- Endothelial Function
Background:
- Ischemic heart disease (IHD) pathogenesis is complex and may involve factors beyond obstructive coronary artery disease (CAD).
- Endothelial dysfunction and inflammation are implicated in cardiovascular disease progression.
- Specific biomarkers like endothelin-1, E-selectin, and TNF-α are associated with endothelial dysfunction and inflammation.
Purpose of the Study:
- To investigate levels of endothelin-1, E-selectin, and TNF-α in patients with IHD.
- To compare these markers between patients with non-obstructive and obstructive coronary artery (CA) disease.
- To assess the association between endothelial dysfunction markers and IHD in the absence of significant CA stenosis.
Main Methods:
- Study included 32 patients with verified IHD, divided into non-obstructive (n=19) and obstructive (n=13) CA disease groups.
- Endothelial dysfunction assessed using photoplethysmography and videocapillaroscopy.
- Serum concentrations of endothelin-1, E-selectin, and TNF-α were measured.
Main Results:
- Patients with non-obstructive CA disease exhibited a trend towards more pronounced endothelial dysfunction compared to the obstructive group, though not statistically significant.
- Significantly higher concentrations of endothelin-1 were observed in the IHD group with non-obstructive CA disease (0.45 ng/ml) versus those with atherosclerotic stenosis (0.35 ng/ml, p=0.035).
- E-selectin concentrations did not differ significantly between groups. TNF-α levels were below the detection threshold in both groups.
Conclusions:
- Endothelial dysfunction and elevated endothelin-1 in non-obstructive CA disease may contribute to IHD pathogenesis.
- These findings suggest potential mechanisms for IHD development independent of hemodynamically significant CA stenoses.
- Low TNF-α levels precluded its use as a diagnostic marker; further research with larger cohorts and alternative markers is warranted.
Abstract:
Aim To determine levels of markers for endothelial dysfunction and inflammation, endothelin-1, E-selectin, and tumor necrosis factor α (TNF-α) in patients with ischemic heart disease (IHD) and non-obstructive and obstructive coronary artery (CA) disease.Material and methods This study included 32 patients with verified IHD and non-obstructive (main group, n=19) and obstructive (comparison group, n=13) CA disease. Endothelial dysfunction was diagnosed by photoplethysmography and videocapillaroscopy. Serum concentrations of endothelin-1, E-selectin, and TNF- α were measured in all patients.Results Patients with non-obstructive CA disease showed a tendency towards more pronounced endothelial dysfunction (alternative stiffness index, 7.8 m /s [6.35; 9.08]; reflection index, 36.95 % [23.4; 52.65]; capillary density following reactive hyperemia, 54.33 cap /mm2 [48.92; 75.83]; capillary density following venous occlusion, 74.33 cap /mm2 [67.83; 93.00]) compared to the comparison group (alternative stiffness index, 9.05 m/s [7.08; 10.58]; reflection index, 28.25 % [23.35; 53.75]; capillary density following reactive hyperemia, 66.83 cap /mm2 [50.83; 78.67]; capillary density following venous occlusion, 87.0 cap /mm2 [77.58; 78.67]), although statistically significant differences were not found. Concentration of endothelin-1 was significantly higher in the IHD group with non-obstructive CA disease (0.45 ng/ml [0.28;0.65]) compared to patients with CA atherosclerotic stenosis (0.35 ng/ml [0.25; 0.38], p=0.035). Concentrations of E-selectin did not significantly differ between the groups (main group, 21.1 ng/ml [18.45; 35.03]; comparison group, 28.55 ng/ml [19.08; 35.01], p=0.29). In both groups, concentrations of TNF-α did not exceed the lower threshold of sensitivity (<2.3 pg/ml).Conclusion Endothelial dysfunction and increased endothelin-1 in patients with non-obstructive CA disease along with inflammation may additionally contribute to the pathogenesis of IHD in the absence of hemodynamically significant CA stenoses. Too low level of TNFα in both groups prevented us from using it as a diagnostic marker. Further study is needed that would include a greater number of patients and a search for alternative markers.
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