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Published on: August 17, 2022
Coronary endothelial dysfunction appears to be a manifestation of a systemic process: A report from the Women's
Sawan Jalnapurkar1, Sofy Landes1, Janet Wei1
1Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
Insights
Renal microvascular dysfunction, indicated by urine albumin-creatinine ratio (UACR), is linked to coronary microvascular dysfunction (CMD) in women with ischemia but no obstructive coronary artery disease (INOCA). This suggests a systemic process affecting blood vessels.
Area of Science:
- Cardiology
- Nephrology
- Vascular Biology
Background:
- Coronary microvascular dysfunction (CMD) is common in women with ischemia and no obstructive coronary artery disease (INOCA).
- Urine albumin-creatinine ratio (UACR) assesses renal microvascular endothelial dysfunction.
- Both CMD and renal dysfunction predict adverse cardiovascular events.
Purpose of the Study:
- To investigate the relationship between renal microvascular dysfunction (measured by UACR) and CMD.
- To determine if CMD in women with INOCA is part of a systemic vascular process.
Main Methods:
- 152 women with suspected INOCA from the WISE-CVD study underwent invasive coronary function testing (CFT).
- Urine albumin and creatinine were measured to calculate UACR.
- Coronary endothelial-dependent and non-endothelial dependent functions were assessed via CFT.
Main Results:
- Women were categorized by UACR: detectable (≥20 mg/g) vs. undetectable (<20 mg/g).
- Coronary endothelial-dependent variables showed significant inverse correlations with log UACR.
- This suggests a link between renal and coronary endothelial function.
Conclusions:
- Renal microvascular dysfunction (UACR) is associated with coronary endothelial-dependent CMD in women with INOCA.
- Findings suggest coronary endothelial dysfunction may be a manifestation of a systemic process.
- Targeting efferent arteriolar vasodilation could be a therapeutic strategy for both conditions.
Background:
Coronary microvascular dysfunction (CMD) is prevalent in symptomatic women with ischemia but no obstructive coronary artery disease (INOCA). Urine albumin-creatinine ratio (UACR) is a measure of renal microvascular endothelial dysfunction. Both are predictors of adverse cardiovascular events. It is unknown if CMD could be a manifestation of a systemic process. We evaluated the relationship between renal microvascular dysfunction and CMD as measured by invasive coronary function testing (CFT).
Methods And Results:
We measured urine albumin and creatinine to provide UACR in 152 women enrolled in the Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study (2008-2015) with suspected INOCA who underwent CFT. Invasive CFT measures of endothelial and non-endothelial dependent coronary microvascular function were obtained. Subjects were divided into those with detectable (≥20 mg/g) and undetectable urine albumin (<20 mg/g). The group mean age was 54 ± 11 years, with a moderate cardiac risk factor burden including low diabetes prevalence, and a mean UACR of 12 ± 55 mg/g (range 9.5-322.7 mg/g). Overall, coronary endothelial-dependent variables (change in coronary blood flow and coronary diameter in response to cold pressor testing) had significant inverse correlations with log UACR (r = -0.17, p = 0.05; r = -0.18, p = 0.03, respectively).
Conclusions:
Among women with INOCA and relatively low risk factor including diabetes burden, renal microvascular dysfunction, measured by UACR, is related to coronary endothelial-dependent CMD. These results suggest that coronary endothelial-dependent function may be a manifestation of a systemic process. Enhancing efferent arteriolar vasodilatation in both coronary endothelial-dependent function and renal microvascular dysfunction pose potential targets for investigation and treatment.
Clinical Trial Registration:
https://clinicaltrials.gov/ct2/show/NCT00832702.
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