The role of myocardial blood volume in the pathophysiology of angina with non-obstructed coronary arteries: The MICORDIS study.

Autor: Vink CEM; Amsterdam UMC Heart Centre, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands., de Jong EAM; Amsterdam UMC Heart Centre, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Department of Cardiology, University Medical Center Utrecht, the Netherlands., Woudstra J; Amsterdam UMC Heart Centre, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands., Molenaar M; Amsterdam UMC Heart Centre, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands., Kamp O; Amsterdam UMC Heart Centre, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands., Götte MJW; Amsterdam UMC Heart Centre, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands., van Raalte DH; Diabetes Center, Department of Internal Medicine, Amsterdam UMC, the Netherlands., Serné E; Diabetes Center, Department of Internal Medicine, Amsterdam UMC, the Netherlands., van de Hoef TP; Department of Cardiology, University Medical Center Utrecht, the Netherlands., Chamuleau SAJ; Amsterdam UMC Heart Centre, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands., Eringa EC; Amsterdam Cardiovascular Sciences, Department of Physiology, Amsterdam UMC, Amsterdam, the Netherlands; Maastricht University, Cardiovascular Research Institute Maastricht, Department of Physiology, Maastricht, the Netherlands., Appelman Y; Amsterdam UMC Heart Centre, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands. Electronic address: y.appelman@amsterdamumc.nl.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2024 Nov 15; Vol. 415, pp. 132479. Date of Electronic Publication: 2024 Aug 22.
DOI: 10.1016/j.ijcard.2024.132479
Abstrakt: Background: Angina with Non-Obstructed Coronary Arteries (ANOCA) involves abnormal vasomotor responses. While reduced coronary flow is an established contributor to myocardial hypoxia, myocardial blood volume (MBV) independently regulates myocardial oxygen uptake but its role in ANOCA remains unclear.
Objectives: We hypothesized that reduced MBV contributes to ANOCA, and associates with insulin resistance in ANOCA.
Methods: MBV in ANOCA patients was compared to age- and sex-matched healthy controls. ANOCA patients underwent coronary angiography with invasive coronary function testing (CFT) to identify vasospasm and coronary microvascular dysfunction. In all subjects MBV was quantified at baseline, during hyperinsulinemia and during dobutamine-induced stress using myocardial contrast echocardiography (MCE). The hyperinsulinemic-euglycemic clamp was used to assess insulin resistance.
Results: Twenty-eight ANOCA patients (21% men, 56.8 ± 8.6 years) and 28 healthy controls (21% men, 56.5 ± 7.0 years) were included. During CFT 11% of patients showed epicardial vasospasm, 39% microvascular vasospasm, 25% coronary microvascular dysfunction, and 11% of patients had a negative CFT. ANOCA patients had significant lower insulin-sensitivity (p < 0.01). During MCE, ANOCA patients showed a significantly lower MBV at baseline (0.388 vs 0.438 mL/mL, p = 0.04), during hyperinsulinemia (0.395 vs 0.447 mL/mL, p = 0.02), and during dobutamine-induced stress (0.401 vs 0.476 mL/mL, p = 0.030).
Conclusions: In ANOCA patients MBV is diminished at baseline, during hyperinsulinemia and dobutamine-induced stress in the absence of differences in microvascular recruitment. These findings support the presence of capillary rarefaction in ANOCA patients. ANOCA patients showed metabolic insulin resistance, but insulin did not acutely alter myocardial perfusion.
Competing Interests: Declaration of competing interest None declared.
(Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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