Assessment of coronary endothelial dysfunction using contemporary coronary function testing.

Area of Science:

• Cardiology
• Vascular Biology
• Diagnostic Imaging

Background:

• Coronary endothelial dysfunction (CED) is traditionally diagnosed using low-dose acetylcholine during coronary function testing (CFT).
• Current criteria involve assessing epicardial vasodilation and coronary blood flow (CBF) changes.
• Accurate diagnosis is crucial for managing patients with angina and non-obstructive coronary arteries.

Purpose of the Study:

• To evaluate the diagnostic utility of using angiographic epicardial vasomotion and CBF as independent criteria for CED diagnosis during CFT.
• To determine if single parameters can effectively replace combined assessments in diagnosing CED.

Main Methods:

• A study included 110 patients with angina and non-obstructive coronary arteries undergoing CFT.
• CED was defined by quantitative coronary angiography showing reduced epicardial diameter and/or <50% increase in CBF post-acetylcholine.
• Analysis compared diagnoses based on current criteria versus using epicardial diameter or CBF alone.

Main Results:

• Using current criteria, 78% of patients were diagnosed with CED.
• Relying solely on epicardial diameter missed 24% of CED cases, while CBF alone missed 27%.
• Both parameters showed similar, insufficient diagnostic yield when used independently (OR: 0.913).

Conclusions:

• Neither epicardial diameter nor CBF alone is sufficient for accurately diagnosing CED.
• Combining both epicardial vasomotion and CBF assessments is essential for a comprehensive diagnosis of CED.
• Using single parameters risks missing diagnoses, particularly microvascular or epicardial CED.