Vascular Remodeling in Coronary Microvascular Dysfunction

Collet C 1 , Sakai K 2 , Mizukami T 3 , Ohashi H 4 , Bouisset F 5 , Caglioni S 6 Show all authors , van Hoe L 7 , Gallinoro E 8 , Bertolone DT 9 , Pardaens S 10 , Brouwers S 11 , Storozhenko T 12 , Seki R 10 , Munhoz D 9 , Tajima A 13 , Buytaert D 10 , Vanderheyden M 10 , Wyffels E 10 , Bartunek J 10 , Sonck J 10 , De Bruyne B 14

Affiliations 

  • 1 Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium. Electronic address: carloscollet@gmail.com
  • 2 Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
  • 3 Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Division of Clinical Pharmacology, Department of Pharmacology, Showa University, Tokyo, Japan; Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
  • 4 Department of Cardiology, Aichi Medical University, Aichi, Japan
  • 5 Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Cardiology, Toulouse University Hospital, Toulouse, France
  • 6 Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
  • 7 Department of Radiology, OLV Clinic, Aalst, Belgium
  • 8 Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; IRCCS Galeazzi-Sant'Ambrogio Hospital, Division of University Cardiology, Milan, Italy
  • 9 Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
  • 10 Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
  • 11 Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
  • 12 Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Prevention and Treatment of Emergency Conditions, L.T. Malaya Therapy National Institute NAMSU, Kharkiv, Ukraine
  • 13 Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Cardiology, Aichi Medical University, Aichi, Japan
  • 14 Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
JACC Cardiovasc Imaging, 2024 Dec;17(12):1463-1476.
PMID: 39269414 DOI: 10.1016/j.jcmg.2024.07.018

Abstract

BACKGROUND: Approximately one-half of the patients with angina and nonobstructive coronary artery disease (ANOCA) have evidence of coronary microvascular dysfunction (CMD).

OBJECTIVES: This study aims to characterize patients with ANOCA by measuring their minimal microvascular resistance and to examine the pattern of vascular remodeling associated with these measurements.

METHODS: The authors prospectively included patients with ANOCA undergoing continuous thermodilution assessment. Lumen volume and vessel-specific myocardial mass were quantified using coronary computed tomography angiography (CTA). CMD was defined as coronary flow reserve <2.5 and high minimal microvascular resistance as >470 WU.

RESULTS: A total of 153 patients were evaluated; 68 had CMD, and 22 of them showed high microvascular resistance. In patients with CMD, coronary flow reserve was 1.9 ± 0.38 vs 3.2 ± 0.81 in controls (P < 0.001). Lumen volume was significantly correlated with minimal microvascular resistance (r = -0.59 [95% CI: -0.45 to -0.71]; P < 0.001). In patients with CMD and high microvascular resistance, lumen volume was 40% smaller than in controls (512.8 ± 130.3 mm3 vs 853.2 ± 341.2 mm3; P < 0.001). Epicardial lumen volume assessed by coronary CTA was independently associated with minimal microvascular resistance (P < 0.001). The predictive capacity of lumen volume from coronary CTA for detecting high microvascular resistance showed an area under the curve of 0.79 (95% CI: 0.69-0.88).

CONCLUSIONS: Patients with CMD and high minimal microvascular resistance have smaller epicardial vessels than those without CMD. Coronary CTA detected high minimal microvascular resistance with very good diagnostic capacity. Coronary CTA could potentially aid in the diagnostic pathway for patients with ANOCA.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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