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Local coronary wall eccentricity and endothelial function are closely related in patients with atherosclerotic coronary artery disease
BACKGROUND: Coronary endothelial function (CEF) in patients with coronary artery disease (CAD) varies among coronary segments in a given patient. Because both coronary vessel wall eccentricity and coronary endothelial dysfunction are predictors of adverse outcomes, we hypothesized that local coronar...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5499038/ https://www.ncbi.nlm.nih.gov/pubmed/28679397 http://dx.doi.org/10.1186/s12968-017-0358-2 |
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author | Hays, Allison G. Iantorno, Micaela Schär, Michael Mukherjee, Monica Stuber, Matthias Gerstenblith, Gary Weiss, Robert G. |
author_facet | Hays, Allison G. Iantorno, Micaela Schär, Michael Mukherjee, Monica Stuber, Matthias Gerstenblith, Gary Weiss, Robert G. |
author_sort | Hays, Allison G. |
collection | PubMed |
description | BACKGROUND: Coronary endothelial function (CEF) in patients with coronary artery disease (CAD) varies among coronary segments in a given patient. Because both coronary vessel wall eccentricity and coronary endothelial dysfunction are predictors of adverse outcomes, we hypothesized that local coronary endothelial dysfunction is associated with local coronary artery eccentricity. METHODS: We used 3 T coronary CMR to measure CEF as changes in coronary cross-sectional area (CSA) and coronary blood flow (CBF) during isometric handgrip exercise (IHE), a known endothelial-dependent stressor, in 29 patients with known CAD and 16 healthy subjects. Black-blood MRI quantified mean coronary wall thickness (CWT) and coronary eccentricity index (EI) and CEF was determined in the same segments. RESULTS: IHE-induced changes in CSA and CBF in healthy subjects (10.6 ± 6.6% and 38.3 ± 29%, respectively) were greater than in CAD patients 1.3 ± 7.7% and 6.5 ± 19.6%, respectively, p < 0.001 vs. healthy for both measures), as expected. Mean CWT and EI in healthy subjects (1.1 ± 0.3 mm 1.9 ± 0.5, respectively) were less than those in CAD patients (1.6 ± 0.4 mm, p < 0.0001; and 2.6 ± 0.6, p = 0.006 vs. healthy). In CAD patients, we observed a significant inverse relationship between stress-induced %CSA change and both EI (r = -0.60, p = 0.0002), and CWT (r = -0.54, p = 0.001). Coronary EI was independently and significantly related to %CSA change with IHE even after controlling for mean CWT (adjusted r = -0.69, p = 0.0001). For every unit increase in EI, coronary CSA during IHE is expected to change by -6.7 ± 9.4% (95% confidence interval: -10.3 to -3.0, p = 0.001). CONCLUSION: There is a significant inverse and independent relationship between coronary endothelial macrovascular function and the degree of local coronary wall eccentricity in CAD patients. Thus anatomic and physiologic indicators of high-risk coronary vascular pathology are closely related. The noninvasive identification of coronary eccentricity and its relationship with underlying coronary endothelial function, a marker of vascular health, may be useful in identifying high-risk patients and culprit lesions. |
format | Online Article Text |
id | pubmed-5499038 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-54990382017-07-10 Local coronary wall eccentricity and endothelial function are closely related in patients with atherosclerotic coronary artery disease Hays, Allison G. Iantorno, Micaela Schär, Michael Mukherjee, Monica Stuber, Matthias Gerstenblith, Gary Weiss, Robert G. J Cardiovasc Magn Reson Research BACKGROUND: Coronary endothelial function (CEF) in patients with coronary artery disease (CAD) varies among coronary segments in a given patient. Because both coronary vessel wall eccentricity and coronary endothelial dysfunction are predictors of adverse outcomes, we hypothesized that local coronary endothelial dysfunction is associated with local coronary artery eccentricity. METHODS: We used 3 T coronary CMR to measure CEF as changes in coronary cross-sectional area (CSA) and coronary blood flow (CBF) during isometric handgrip exercise (IHE), a known endothelial-dependent stressor, in 29 patients with known CAD and 16 healthy subjects. Black-blood MRI quantified mean coronary wall thickness (CWT) and coronary eccentricity index (EI) and CEF was determined in the same segments. RESULTS: IHE-induced changes in CSA and CBF in healthy subjects (10.6 ± 6.6% and 38.3 ± 29%, respectively) were greater than in CAD patients 1.3 ± 7.7% and 6.5 ± 19.6%, respectively, p < 0.001 vs. healthy for both measures), as expected. Mean CWT and EI in healthy subjects (1.1 ± 0.3 mm 1.9 ± 0.5, respectively) were less than those in CAD patients (1.6 ± 0.4 mm, p < 0.0001; and 2.6 ± 0.6, p = 0.006 vs. healthy). In CAD patients, we observed a significant inverse relationship between stress-induced %CSA change and both EI (r = -0.60, p = 0.0002), and CWT (r = -0.54, p = 0.001). Coronary EI was independently and significantly related to %CSA change with IHE even after controlling for mean CWT (adjusted r = -0.69, p = 0.0001). For every unit increase in EI, coronary CSA during IHE is expected to change by -6.7 ± 9.4% (95% confidence interval: -10.3 to -3.0, p = 0.001). CONCLUSION: There is a significant inverse and independent relationship between coronary endothelial macrovascular function and the degree of local coronary wall eccentricity in CAD patients. Thus anatomic and physiologic indicators of high-risk coronary vascular pathology are closely related. The noninvasive identification of coronary eccentricity and its relationship with underlying coronary endothelial function, a marker of vascular health, may be useful in identifying high-risk patients and culprit lesions. BioMed Central 2017-07-06 /pmc/articles/PMC5499038/ /pubmed/28679397 http://dx.doi.org/10.1186/s12968-017-0358-2 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Hays, Allison G. Iantorno, Micaela Schär, Michael Mukherjee, Monica Stuber, Matthias Gerstenblith, Gary Weiss, Robert G. Local coronary wall eccentricity and endothelial function are closely related in patients with atherosclerotic coronary artery disease |
title | Local coronary wall eccentricity and endothelial function are closely related in patients with atherosclerotic coronary artery disease |
title_full | Local coronary wall eccentricity and endothelial function are closely related in patients with atherosclerotic coronary artery disease |
title_fullStr | Local coronary wall eccentricity and endothelial function are closely related in patients with atherosclerotic coronary artery disease |
title_full_unstemmed | Local coronary wall eccentricity and endothelial function are closely related in patients with atherosclerotic coronary artery disease |
title_short | Local coronary wall eccentricity and endothelial function are closely related in patients with atherosclerotic coronary artery disease |
title_sort | local coronary wall eccentricity and endothelial function are closely related in patients with atherosclerotic coronary artery disease |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5499038/ https://www.ncbi.nlm.nih.gov/pubmed/28679397 http://dx.doi.org/10.1186/s12968-017-0358-2 |
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