Epicardial and microvascular coronary vasomotor dysfunction and its relation to myocardial ischemic burden in patients with non-obstructive coronary artery disease

  • Edoardo Verna
  • Sergio Ghiringhelli
  • Stefano Provasoli
  • Simone Scotti
  • Jorge Salerno-Uriarte
Original Article
First Online:
Received:
Revised:

Abstract

Aim

To assess the relative contribution of epicardial endothelium-dependent (EDD) and microvascular endothelium-independent (EIMVD) coronary vasomotor dysfunction to the extent of myocardial ischemia in patients with normal angiograms or non-obstructive coronary artery disease (NOCAD).

Methods

Coronary vasomotion was evaluated by quantitative angiography and blood flow (CBF) measurements during intracoronary acetylcholine, nitroglycerine, and adenosine in 101 patients. Myocardial SPECT ischemic burden was evaluated by semi-quantitative scoring of summed stress (SSS) and summed ischemic (SDS) perfusion defect size.

Results

Coronary vasomotor dysfunction was found in most patients (83; 77%) with a divergent behavior of EDD and EIMVD in one half of them (52.4%). There was no significant difference in SDS between patients with and without EIMVD, whereas SDS was significantly greater in subjects with EDD as compared to patients with normal response to acetylcholine (4.31 ± 2.44 vs 1.35 ± 1.45; P < .0001). Patients with EDD, either alone or in combination with EIMVD, had significantly higher SSS as compared to patients with lone EIMVD or normal vasomotor function (8.50 ± 5.32; 5.55 ± 3.21; 2.60 ± 2.14; and 1.74 ± 1.66, respectively; P < .0001). Acetylcholine CBF correlated inversely with both SDS (r = −0.545; P < .001) and SSS (r = 0.538; P < .001).

Conclusions

In NOCAD patients with symptoms and signs of myocardial ischemia, vasomotor dysfunction is common. EDD is associated with greater extent of ischemia as compared to isolated EIMVD. Thus, assessment of both EIMVD and EDD is needed to recognize mechanisms of ischemia and identify patients with greater ischemic burden.

Keywords

Coronary artery disease Myocardial perfusion imaging (SPECT) Endothelial dysfunction Coronary blood flow Microvascular disease 

Abbreviations

NOCAD

Non-obstructive coronary artery disease

APV

Average peak velocity

CFVR

Coronary flow velocity reserve

CBF

Coronary blood flow

Ach

Acetylcholine

NTG

Nitroglycerine

AND

Adenosine

EDD

Epicardial endothelium-dependent dysfunction

EIMVD

Endothelium-independent microvascular dysfunction

SPECT

Single-photon emission computed tomography

SSS

Summed stress score

SRS

Summed rest score

SDS

Summed difference score

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Notes

Acknowledgements

We thank the staff of the Nuclear Medicine and of the Catheterization Laboratory for their dedicated work and daily help. We are indebted to Chiara Minoia MD (Varese, Italy) for her contribution in data collection and to Luca Ceriani MD (Nuclear Medicine, Istituto Oncologico della Svizzera Italiana (IOSI), Bellinzona, Lugano, Switzerland for his skilled work in the evaluation of the first nuclear studies.

Disclosure

The authors have no conflicts of interest to disclose. All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Supplementary material

12350_2017_871_MOESM1_ESM.pptx (386 kb)
Supplementary material 1 (PPTX 386 kb)

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Copyright information

© American Society of Nuclear Cardiology 2017

Authors and Affiliations

  • Edoardo Verna
    • 1
  • Sergio Ghiringhelli
    • 1
  • Stefano Provasoli
    • 1
  • Simone Scotti
    • 2
  • Jorge Salerno-Uriarte
    • 1
  1. 1.Department of Cardiology, Ospedale di Circolo & Fondazione Macchi, University Hospital-VareseUniversità dell’InsubriaVareseItaly
  2. 2.Nuclear Medicine, Ospedale di Circolo & Fondazione Macchi, University HospitalUniversità dell’InsubriaVareseItaly

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