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Published on: January 28, 2020
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Coronary Microvascular Dysfunction: Features and Prognostic Value
Kristina Kopeva1, Elena Grakova1, Alina Maltseva2
1Department of Myocardial Pathology, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk 634009, Russia.
Journal of Clinical Medicine
|April 28, 2023
Summary
Coronary microvascular dysfunction (CMD) is linked to worse outcomes and severe diastolic dysfunction. Identifying CMD early is crucial for managing patients with non-obstructive coronary artery disease.
Area of Science:
- Cardiology
- Vascular Biology
- Diagnostic Imaging
Background:
- Coronary microvascular dysfunction (CMD) is increasingly recognized as a significant contributor to adverse cardiovascular events.
- Pathophysiology of CMD remains incompletely understood, necessitating further clinical investigation.
- International studies highlight CMD's prevalence and association with poor prognosis, yet accurate comprehension is lacking.
Purpose of the Study:
- To investigate the clinical and instrumental characteristics of CMD in patients with non-obstructive coronary artery disease.
- To assess the prognostic implications of CMD over a 12-month follow-up period.
- To identify independent predictors associated with the presence of CMD.
Main Methods:
- 118 patients with non-obstructive coronary artery disease and preserved left ventricular ejection fraction were enrolled.
- Coronary microvascular dysfunction (CMD) was diagnosed using dynamic CZT-SPECT to measure myocardial flow reserve (MFR).
- Serum biomarkers, NT-proBNP and soluble ST2, and left ventricular diastolic dysfunction were assessed.
Main Results:
- Patients with CMD (MFR ≤ 2) exhibited more severe diastolic dysfunction and elevated fibrosis/inflammation biomarkers compared to those without CMD.
- Diastolic dysfunction, NT-proBNP ≥ 760.5 pg/mL, and soluble ST2 ≥ 31.4 ng/mL were independent predictors of CMD.
- A significantly higher rate of adverse outcomes (45.2%) was observed in patients with CMD versus those without (8.6%) over 12 months.
Conclusions:
- CMD is associated with severe diastolic dysfunction and heightened biomarkers of fibrosis and inflammation.
- The presence of CMD independently predicts adverse cardiovascular outcomes.
- Early identification and management of CMD are critical for improving patient prognosis in non-obstructive coronary artery disease.
Keywords:
biomarkerscoronary microvascular dysfunctionfibrosisinflammationnon-obstructive coronary artery diseasepreserved ejection fractionMore Related Videos
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