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Altered coronary endothelial function in a patient with asymptomatic left ventricular dysfunction
C R Cannan1, M D McGoon, D R Holmes
1Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
Insights
Coronary endothelial dysfunction was observed in an asymptomatic patient with early cardiomyopathy. This suggests the endothelium plays a crucial role in the initial stages of heart failure development.
Area of Science:
- Cardiology
- Vascular Biology
- Heart Failure Pathophysiology
Background:
- Coronary endothelial dysfunction is linked to symptomatic heart failure.
- Endothelial dysfunction is implicated in cardiomyopathy pathogenesis, even with normal coronary angiograms.
- The endothelium's role in early, asymptomatic heart failure remains less understood.
Observation:
- An asymptomatic patient presented with early-stage cardiomyopathy.
- Coronary angiography and intravascular ultrasound showed no signs of coronary artery disease.
- Intracoronary acetylcholine infusion induced epicardial coronary artery vasoconstriction and reduced coronary blood flow.
Findings:
- The patient exhibited abnormal coronary endothelial function.
- Endothelial dysfunction was present despite the absence of overt coronary disease.
- Left ventricular dysfunction was evident in an asymptomatic individual.
Implications:
- Endothelial dysfunction can occur in asymptomatic left ventricular dysfunction.
- This case underscores the endothelium's potential significance in the early development of heart failure.
- Further research into endothelial function may reveal novel therapeutic targets for preventing heart failure progression.
Abstract:
Coronary endothelial dysfunction has been demonstrated in patients with symptomatic heart failure. Furthermore the endothelium has been implicated in the pathogensis of cardiomyopathy in patients with normal coronary angiograms and no other known causes of heart failure. Herein we describe an asymptomatic patient with an early cardiomyopathy and abnormal coronary endothelial function. There was no evidence for coronary disease by both angiography and intravascular ultrasound. Epicardial coronary artery vasoconstriction and a decrease in coronary blood flow was noted during the intracoronary infusion of graded concentrations of acetylcholine. This case demonstrates that endothelial dysfunction occurs in the setting of asymptomatic left ventricular dysfunction and highlights the potential importance of the endothelium in the early development of heart failure.