Non-invasive assessment of microvascular dysfunction in patients with microvascular angina.

Autor: Jaarsma C; Department of Cardiology, Maastricht University Medical Center, The Netherlands., Vink H; Department of Physiology, Maastricht University, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands., van Haare J; Department of Physiology, Maastricht University, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands., Bekkers SCAM; Department of Cardiology, Maastricht University Medical Center, The Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands., van Rooijen BD; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, The Netherlands., Backes WH; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, The Netherlands., Wildberger JE; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands., Crijns HJ; Department of Cardiology, Maastricht University Medical Center, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands., van Teeffelen J; Department of Physiology, Maastricht University, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands., Schalla S; Department of Cardiology, Maastricht University Medical Center, The Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands. Electronic address: s.schalla@mumc.nl.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2017 Dec 01; Vol. 248, pp. 433-439. Date of Electronic Publication: 2017 Jul 18.
DOI: 10.1016/j.ijcard.2017.05.010
Abstrakt: Background: We aimed to evaluate the microvascular function in patients with microvascular angina (MVA) by assessing 1) the endothelial glycocalyx barrier properties using sublingual microscopy, and 2) the myocardial perfusion reserve using cardiovascular magnetic resonance (CMR) imaging.
Methods: Sublingual microscopy was performed in 13 MVA patients (angina pectoris, ST-depression on treadmill testing, normal coronary angiogram) and compared with 2 control groups of 13 volunteers and 14 patients with known obstructive coronary artery disease (CAD). To test the glycocalyx-mediated microvascular responsiveness, the erythrocyte perfused boundary region (PBR) was assessed at baseline and after nitroglycerin challenge.
Results: The baseline PBR of MVA patients was similar to controls with CAD (p=0.72), and larger than in volunteers (p=0.02). Only the volunteers demonstrated a significant increase in PBR after nitroglycerin (p=0.03). In the 13 MVA patients, adenosine stress CMR perfusion imaging was performed. Although a significant increase in myocardial perfusion was observed in both the subendocardium and subepicardium during stress, the subendocardial perfusion reserve was significantly lower (p=0.02). The PBR responsiveness of the sublingual microvasculature showed a strong correlation with the transmural myocardial perfusion reserve (r=0.86, p<0.001).
Conclusions: Patients with MVA can be characterized by microvascular glycocalyx dysfunction using sublingual microscopy. The strong correlation between sublingual PBR responsiveness and myocardial perfusion reserve suggests that the glycocalyx may play an important role in the regulation of microvascular volume for myocardial perfusion and supports the concept of impaired glycocalyx barrier properties in MVA.
(Copyright © 2017 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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