Impaired peripheral microvascular reactivity in patients with nonobstructive coronary artery disease
Zulkefli Sanip1, Nurnajwa Pahimi2,3, Nur Adilah Bokti3,4
1Central Research Laboratory, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia.
Insights
Patients with nonobstructive coronary artery disease (NOCAD) exhibit impaired peripheral microvascular reactivity, showing reduced blood flow recovery after an ischemic stimulus. This indicates microvascular dysfunction even without significant coronary artery blockages.
Area of Science:
- Cardiology
- Vascular Biology
- Diagnostic Medicine
Background:
- Coronary artery disease (CAD) diagnosis typically relies on identifying obstructive lesions.
- Nonobstructive coronary artery disease (NOCAD) presents a diagnostic challenge, as patients experience angina-like symptoms without significant arterial stenosis.
- Microvascular dysfunction is increasingly recognized as a contributor to ischemic symptoms in patients with and without obstructive CAD.
Purpose of the Study:
- To investigate peripheral microvascular reactivity in patients diagnosed with nonobstructive coronary artery disease (NOCAD).
- To compare microvascular function between patients with NOCAD, obstructive coronary artery disease (OCAD), and healthy controls.
Main Methods:
- Recruitment of stable angina patients categorized into OCAD (stenosis ≥50%) and NOCAD (stenosis <50%) groups, plus a control group.
- Assessment of forearm skin microvascular reactivity using laser Doppler blood perfusion monitoring.
- Measurement of postocclusive reactive hyperemia (PORH) to quantify reperfusion response.
Main Results:
- Both OCAD and NOCAD groups showed significantly lower PORH percent change compared to controls.
- No significant difference in PORH percent change was observed between OCAD and NOCAD groups.
- NOCAD patients exhibited a delayed peak perfusion and reduced PORH percent change versus the nonangina control group.
Conclusions:
- Patients with NOCAD demonstrate microvascular dysfunction, evidenced by diminished reperfusion following an ischemic stimulus.
- NOCAD is associated with impaired microvascular response, even in the absence of coronary obstruction.
- Peripheral microvascular reactivity assessment may aid in understanding angina symptoms in NOCAD patients.
Objective:
This study aimed to determine whether peripheral microvascular reactivity is impaired in patients with nonobstructive coronary artery disease (NOCAD).
Methods:
Stable patients presenting with angina were recruited and, based on results from coronary angiography, were categorized into OCAD (coronary stenosis of ≥50%) and NOCAD (stenosis <50%) groups. A control group with no history of angina was also recruited. Forearm skin microvascular reactivity was measured using the laser Doppler blood perfusion monitor and the process of postocclusive skin reactive hyperemia (PORH).
Results:
Patients were categorized into OCAD (n = 42), NOCAD (n = 40), and control (n = 39) groups. Compared with the control group, the PORH perfusion percent change (PORH% change) was significantly lower in the OCAD and NOCAD groups. No significant differences were noted between the OCAD and NOCAD groups. Additionally, the NOCAD group without any coronary obstruction takes a longer time to reach peak perfusion and had lower PORH% change compared with the nonangina control group.
Conclusion:
Angina patients with NOCAD have microvascular dysfunction as demonstrated by reduced magnitude of reperfusion with an ischemic stimulus. NOCAD patients without coronary obstruction also displayed a slower response to reperfusion.
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