Endothelial Cell-Derived Extracellular Vesicles Allow to Differentiate Between Various Endotypes of INOCA: A
Aleksandra Gąsecka1,2, Piotr Szolc3,4, Edwin van der Pol5,6
11st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097, Warsaw, Poland. gaseckaa@gmail.com.
Insights
Ischemia and non-obstructive coronary artery disease (INOCA) involves coronary microvascular dysfunction (CMD) or vasospastic angina (VSA). A lower ratio of endothelial extracellular vesicles (EVs) may indicate a mixed INOCA endotype.
Area of Science:
- Cardiology
- Biomarkers
- Extracellular Vesicles
Background:
- Ischemia and non-obstructive coronary artery disease (INOCA) presents diagnostic challenges, potentially stemming from coronary microvascular dysfunction (CMD), vasospastic angina (VSA), or a combination.
- Understanding the distinct endotypes of INOCA is crucial for accurate diagnosis and targeted treatment strategies.
Purpose of the Study:
- To compare plasma extracellular vesicle (EV) concentrations across different INOCA endotypes.
- To identify potential circulating biomarkers for differentiating INOCA subtypes.
Main Methods:
- Plasma samples from 96 patients were analyzed using flow cytometry to quantify various EVs.
- Patients were categorized into INOCA subgroups (CMD, VSA, mixed CMD+VSA) and a control group with non-anginal chest pain.
Main Results:
- Patients with INOCA exhibited a lower ratio of endothelial EVs (CD144+) to total EVs compared to those with non-anginal chest pain.
- The mixed CMD+VSA endotype showed a significantly decreased ratio of endothelial EVs to total EVs compared to CMD, VSA, and non-anginal pain groups.
- This reduced endothelial EV ratio may serve as a circulating biomarker for the mixed INOCA endotype.
Conclusions:
- The ratio of endothelial EVs to total EVs is a potential indicator for identifying patients with mixed CMD and VSA.
- This finding could lead to improved diagnostic approaches for complex INOCA cases.
Abstract:
Ischemia and non-obstructive coronary artery disease (INOCA) might be due to coronary microvascular dysfunction (CMD), vasospastic angina (VSA) or both. We compared plasma concentration of various extracellular vesicles (EVs) in patients with different INOCA endotypes. Patients were divided into those with INOCA (CMD, VSA, mixed CMD + VSA) and non-anginal chest pain. Plasma concentrations of EVs were measured using flow cytometry. Out of 96 patients included, 34 had CMD (35%), 15 VSA (16%), 24 mixed endotype (25%) and 23 non-anginal chest pain (24%). Patients with INOCA had lower ratio of endothelial EVs (CD144 +) to total EVs, compared to patients with non-anginal pain (p = 0.027). Patients with mixed endotype had lower ratio of endothelial EVs (CD144 +) to total EVs, compared to CMD (p = 0.008), VSA (p = 0.014) and non-anginal pain (p < 0.001). Decreased ratio of endothelial EVs (CD144 +) to total EVs might serve as a "circulating footprint" of the mixed INOCA endotype.
