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Association of vascular endothelial function and quality of life in patients with ischemia and non-obstructive coronary artery disease

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Abstract

Improvements are required in the quality of life (QoL) of patients with ischemia and non-obstructive coronary artery disease (INOCA). Several patients with INOCA experience vascular endothelial dysfunction. However, the relationship between endothelial function and QoL remains unelucidated. This study aimed to initially investigate the relationship between endothelial function and QoL in patients with INOCA. This prospective observational study included 121 patients with INOCA (aged 31–85 years). Vascular endothelial function was assessed by flow-mediated dilatation (FMD) of the peripheral brachial artery. QoL was evaluated using the 36-Item Short-Form Health Survey (SF-36). Patients with INOCA were divided into two groups according to the median FMD change during the 1-year follow-up (group A, ≥ median FMD change cut-off; group B, < median FMD change cut-off). The median change in FMD was 0.92%. The mean baseline SF-36 scores were comparable between the two groups (53.95 ± 6.46 vs. 53.92 ± 4.29, p = 0.98). The QoL at follow-up was better in group A than in group B (56.61 ± 5.50 vs. 53.32 ± 5.58, p = 0.002). The change in FMD (r = 0.34, p < 0.01), rather than FMD at baseline (r = − 0.01, p = 0.89) or follow-up (r = 0.13, p = 0.15), was related to the follow-up SF-36 scores. FMD improvement was an independent predictor of increased QoL (odds ratio, 3.90; 95% confidence interval: 1.59–9.53, p = 0.003). Endothelial function change is associated with QoL, and patients with improved endothelial function have a better QoL than those without.

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Data availability

Original data of this study are available from the corresponding author upon reasonable request.

References

  1. Timmis A, Townsend N, Gale C, Grobbee R, Maniadakis N, Flather M, Wilkins E, Wright L, Vos R, Bax J, Blum M, Pinto F, Vardas P, Group ESCSD (2018) European Society of Cardiology: cardiovascular disease statistics 2017. Eur Heart J 39(7):508–579

    Article  PubMed  Google Scholar 

  2. Anderson RD, Petersen JW, Mehta PK, Wei J, Johnson BD, Handberg EM, Kar S, Samuels B, Azarbal B, Kothawade K, Kelsey SF, Sharaf B, Shaw LJ, Sopko G, Bairey Merz CN, Pepine CJ (2019) Prevalence of coronary endothelial and microvascular dysfunction in women with symptoms of ischemia and no obstructive coronary artery disease is confirmed by a new cohort: the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD). J Interv Cardiol 2019:7169275

    Article  PubMed  PubMed Central  Google Scholar 

  3. Gulati M, Cooper-DeHoff RM, McClure C, Johnson BD, Shaw LJ, Handberg EM, Zineh I, Kelsey SF, Arnsdorf MF, Black HR, Pepine CJ, Merz CN (2009) Adverse cardiovascular outcomes in women with nonobstructive coronary artery disease: a report from the Women’s Ischemia Syndrome Evaluation Study and the St James women take heart project. Arch Intern Med 169(9):843–850

    Article  PubMed  PubMed Central  Google Scholar 

  4. Jespersen L, Hvelplund A, Abildstrom SZ, Pedersen F, Galatius S, Madsen JK, Jorgensen E, Kelbaek H, Prescott E (2012) Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events. Eur Heart J 33(6):734–744

    Article  PubMed  Google Scholar 

  5. Shaw LJ, Merz CN, Pepine CJ, Reis SE, Bittner V, Kip KE, Kelsey SF, Olson M, Johnson BD, Mankad S, Sharaf BL, Rogers WJ, Pohost GM, Sopko G, Women’s Ischemia Syndrome Evaluation I (2006) The economic burden of angina in women with suspected ischemic heart disease: results from the national institutes of health-national heart, lung, and blood institute–sponsored women’s Ischemia syndrome evaluation. Circulation 114(9):894–904

    Article  PubMed  Google Scholar 

  6. Wheeler A, Schrader G, Tucker G, Adams R, Tavella R, Beltrame JF (2013) Prevalence of depression in patients with chest pain and non-obstructive coronary artery disease. Am J Cardiol 112(5):656–659

    Article  PubMed  Google Scholar 

  7. Bairey Merz CN, Pepine CJ, Walsh MN, Fleg JL (2017) Ischemia and no obstructive coronary artery disease (INOCA): developing evidence-based therapies and research agenda for the next decade. Circulation 135(11):1075–1092

    Article  PubMed  Google Scholar 

  8. Ford TJ, Yii E, Sidik N, Good R, Rocchiccioli P, McEntegart M, Watkins S, Eteiba H, Shaukat A, Lindsay M, Robertson K, Hood S, McGeoch R, McDade R, McCartney P, Corcoran D, Collison D, Rush C, Stanley B, McConnachie A, Sattar N, Touyz RM, Oldroyd KG, Berry C (2019) Ischemia and no obstructive coronary artery disease: prevalence and correlates of coronary vasomotion disorders. Circ Cardiovasc Interv 12(12):e008126

    Article  PubMed  PubMed Central  Google Scholar 

  9. Shaw J, Anderson T (2016) Coronary endothelial dysfunction in non-obstructive coronary artery disease: risk, pathogenesis, diagnosis and therapy. Vasc Med 21(2):146–155

    Article  CAS  PubMed  Google Scholar 

  10. Pepine CJ (2015) Multiple causes for ischemia without obstructive coronary artery disease: not a short list. Circulation 131(12):1044–1046

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sara JD, Widmer RJ, Matsuzawa Y, Lennon RJ, Lerman LO, Lerman A (2015) Prevalence of coronary microvascular dysfunction among patients with chest pain and nonobstructive coronary artery disease. JACC Cardiovasc Interv 8(11):1445–1453

    Article  PubMed  Google Scholar 

  12. Corretti MC, Anderson TJ, Benjamin EJ, Celermajer D, Charbonneau F, Creager MA, Deanfield J, Drexler H, Gerhard-Herman M, Herrington D, Vallance P, Vita J, Vogel R (2002) Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the international brachial artery reactivity task force. J Am Coll Cardiol 39(2):257–265

    Article  PubMed  Google Scholar 

  13. Alexander Y, Osto E, Schmidt-Trucksass A, Shechter M, Trifunovic D, Duncker DJ, Aboyans V, Back M, Badimon L, Cosentino F, De Carlo M, Dorobantu M, Harrison DG, Guzik TJ, Hoefer I, Morris PD, Norata GD, Suades R, Taddei S, Vilahur G, Waltenberger J, Weber C, Wilkinson F, Bochaton-Piallat ML, Evans PC (2021) Endothelial function in cardiovascular medicine: a consensus paper of the European Society of Cardiology Working Groups on atherosclerosis and vascular biology, aorta and peripheral vascular diseases, coronary pathophysiology and microcirculation, and thrombosis. Cardiovasc Res 117(1):29–42

    Article  CAS  PubMed  Google Scholar 

  14. Anderson TJ, Uehata A, Gerhard MD, Meredith IT, Knab S, Delagrange D, Lieberman EH, Ganz P, Creager MA, Yeung AC et al (1995) Close relation of endothelial function in the human coronary and peripheral circulations. J Am Coll Cardiol 26(5):1235–1241

    Article  CAS  PubMed  Google Scholar 

  15. Nerla R, Tarzia P, Sestito A, Di Monaco A, Infusino F, Matera D, Greco F, Tacchino RM, Lanza GA, Crea F (2012) Effect of bariatric surgery on peripheral flow-mediated dilation and coronary microvascular function. Nutr Metab Cardiovasc Dis 22(8):626–634

    Article  CAS  PubMed  Google Scholar 

  16. Nardone M, Miner S, McCarthy M, Ardern CI, Edgell H (2020) Noninvasive microvascular indices reveal peripheral vascular abnormalities in patients with suspected coronary microvascular dysfunction. Can J Cardiol 36(8):1289–1297

    Article  PubMed  Google Scholar 

  17. Goldstein BH, Urbina EM, Khoury PR, Gao Z, Amos MA, Mays WA, Redington AN, Marino BS (2016) Endothelial function and arterial stiffness relate to functional outcomes in adolescent and young adult Fontan survivors. J Am Heart Assoc 5(9):e004258

    Article  PubMed  PubMed Central  Google Scholar 

  18. Swift DL, Irving BA, Brock DW, Davis CK, Barrett EJ, Gaesser GA, Weltman A (2007) Heart rate recovery does not predict endothelial function in obese women. Obe Metab 3(3):101–105

    PubMed  PubMed Central  Google Scholar 

  19. Li L, Wang H, Shen Y (2002) Development and psychometric tests of a Chinese version of the SF-36 health survey scales. Zhonghua Yu Fang Yi Xue Za Zhi 36(2):109–113

    PubMed  Google Scholar 

  20. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30(6):473–483

    Article  PubMed  Google Scholar 

  21. Wong CK, Wong WC, Wan EY, Wong WH, Chan FW, Lam CL (2015) Increased number of structured diabetes education attendance was not associated with the improvement in patient-reported health-related quality of life: results from Patient Empowerment Programme (PEP). Health Qual Life Outcomes 13:126

    Article  PubMed  PubMed Central  Google Scholar 

  22. Jespersen L, Abildstrom SZ, Hvelplund A, Prescott E (2013) Persistent angina: highly prevalent and associated with long-term anxiety, depression, low physical functioning, and quality of life in stable angina pectoris. Clin Res Cardiol 102(8):571–581

    Article  PubMed  Google Scholar 

  23. Sara JDS, Corban MT, Prasad M, Prasad A, Gulati R, Lerman LO, Lerman A (2020) Prevalence of myocardial bridging associated with coronary endothelial dysfunction in patients with chest pain and non-obstructive coronary artery disease. EuroIntervention 15(14):1262–1268

    Article  PubMed  Google Scholar 

  24. Pargaonkar VS, Kobayashi Y, Kimura T, Schnittger I, Chow EKH, Froelicher VF, Rogers IS, Lee DP, Fearon WF, Yeung AC, Stefanick ML, Tremmel JA (2019) Accuracy of non-invasive stress testing in women and men with angina in the absence of obstructive coronary artery disease. Int J Cardiol 282:7–15

    Article  PubMed  Google Scholar 

  25. Maruhashi T, Soga J, Fujimura N, Idei N, Mikami S, Iwamoto Y, Iwamoto A, Kajikawa M, Matsumoto T, Oda N, Kishimoto S, Matsui S, Hashimoto H, Aibara Y, Mohamad Yusoff F, Hidaka T, Kihara Y, Chayama K, Noma K, Nakashima A, Goto C, Tomiyama H, Takase B, Kohro T, Suzuki T, Ishizu T, Ueda S, Yamazaki T, Furumoto T, Kario K, Inoue T, Koba S, Watanabe K, Takemoto Y, Hano T, Sata M, Ishibashi Y, Node K, Maemura K, Ohya Y, Furukawa T, Ito H, Ikeda H, Yamashina A, Higashi Y (2018) Endothelial dysfunction, increased arterial stiffness, and cardiovascular risk prediction in patients with coronary artery disease: FMD-J (Flow-Mediated Dilation Japan) Study A. J Am Heart Assoc 7(14):e008588

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Kitta Y, Obata JE, Nakamura T, Hirano M, Kodama Y, Fujioka D, Saito Y, Kawabata K, Sano K, Kobayashi T, Yano T, Nakamura K, Kugiyama K (2009) Persistent impairment of endothelial vasomotor function has a negative impact on outcome in patients with coronary artery disease. J Am Coll Cardiol 53(4):323–330

    Article  PubMed  Google Scholar 

  27. Reriani M, Flammer AJ, Duhe J, Li J, Gulati R, Rihal CS, Lennon R, Tilford JM, Prasad A, Lerman LO, Lerman A (2019) Coronary endothelial function testing may improve long-term quality of life in subjects with microvascular coronary endothelial dysfunction. Open Heart 6(1):e000870

    Article  PubMed  PubMed Central  Google Scholar 

  28. Matsuzawa Y, Kwon TG, Lennon RJ, Lerman LO, Lerman A (2015) Prognostic value of flow-mediated vasodilation in brachial artery and fingertip artery for cardiovascular events: a systematic review and meta-analysis. J Am Heart Assoc 4(11):e002270

    Article  PubMed  PubMed Central  Google Scholar 

  29. Conraads VM, Pattyn N, De Maeyer C, Beckers PJ, Coeckelberghs E, Cornelissen VA, Denollet J, Frederix G, Goetschalckx K, Hoymans VY, Possemiers N, Schepers D, Shivalkar B, Voigt JU, Van Craenenbroeck EM, Vanhees L (2015) Aerobic interval training and continuous training equally improve aerobic exercise capacity in patients with coronary artery disease: the SAINTEX-CAD study. Int J Cardiol 179:203–210

    Article  PubMed  Google Scholar 

  30. Verna E, Ghiringhelli S, Provasoli S, Scotti S, Salerno-Uriarte J (2018) Epicardial and microvascular coronary vasomotor dysfunction and its relation to myocardial ischemic burden in patients with non-obstructive coronary artery disease. J Nucl Cardiol 25(5):1760–1769

    Article  PubMed  Google Scholar 

  31. Lee SR, Chae IH, Kim HL, Kang DY, Kim SH, Kim HS (2017) Predictors of candesartan’s effect on vascular reactivity in patients with coronary artery disease. Cardiovasc Ther 35(5):e12291

    Article  PubMed  Google Scholar 

  32. Silva IVG, de Figueiredo RC, Rios DRA (2019) Effect of different classes of antihypertensive drugs on endothelial function and inflammation. Int J Mol Sci 20(14):3458

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Fearon WF, Okada K, Kobashigawa JA, Kobayashi Y, Luikart H, Sana S, Daun T, Chmura SA, Sinha S, Cohen G, Honda Y, Pham M, Lewis DB, Bernstein D, Yeung AC, Valantine HA, Khush K (2017) Angiotensin-converting enzyme inhibition early after heart transplantation. J Am Coll Cardiol 69(23):2832–2841

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Imanishi T, Kuroi A, Ikejima H, Kobayashi K, Muragaki Y, Mochizuki S, Goto M, Yoshida K, Akasaka T (2008) Effects of angiotensin converting enzyme inhibitor and angiotensin II receptor antagonist combination on nitric oxide bioavailability and atherosclerotic change in Watanabe heritable hyperlipidemic rabbits. Hypertens Res 31(3):575–584

    Article  CAS  PubMed  Google Scholar 

  35. Shi Y, Vanhoutte PM (2017) Macro- and microvascular endothelial dysfunction in diabetes. J Diabetes 9(5):434–449

    Article  CAS  PubMed  Google Scholar 

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Funding

This work was supported by the Beijing Municipal Natural Science Foundation [grant number 7192078]; the Beijing Municipal Hundred-Thousand-Ten thousand Talents Project [grant number 2017A05].

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  1. Keling Xiao and Machao Liu share first authorship.

Authors and Affiliations

  1. Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, #45 Changchun Street, Xicheng District, Beijing, 100053, China

    Keling Xiao, Yinghua Zhang, Jin Si, Ning Shi, Lijie Sun, Zupei Miao, Haoyu Zhang, Ting Zhao & Jing Li

  2. Division of Cardiology, Xuanwu Hospital Capital Medical University, #45 Changchun Street, Xicheng District, Beijing, 100053, China

    Machao Liu, Xipeng Sun, Zhi Liu, Zhenxing Fan & Jing Gao

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  1. Keling Xiao
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Contributions

Conception and design or analysis and interpretation of data: JL, JG, KLX and MCL. Drafting of the manuscript or revising it critically for important intellectual content: KLX, MCL, JL, JG, XPS, YHZ, JS, NS, LJS, ZPM, HYZ, TZ, ZL and ZXF. Final approval of the manuscript submitted: JL, JG, KLX and MCL.

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Correspondence to Jing Gao or Jing Li.

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Xiao, K., Liu, M., Sun, X. et al. Association of vascular endothelial function and quality of life in patients with ischemia and non-obstructive coronary artery disease. Heart Vessels 38, 617–625 (2023). https://doi.org/10.1007/s00380-022-02213-w

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