TY - JOUR
T1 - The role of myocardial blood volume in the pathophysiology of angina with non-obstructed coronary arteries
T2 - The MICORDIS study
AU - Vink, Caitlin E.M.
AU - de Jong, Elize A.M.
AU - Woudstra, Janneke
AU - Molenaar, Mitchel
AU - Kamp, Otto
AU - Götte, Marco J.W.
AU - van Raalte, Daniel H.
AU - Serné, Erik
AU - van de Hoef, Tim P.
AU - Chamuleau, Steven A.J.
AU - Eringa, Etto C.
AU - Appelman, Yolande
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2024/11/15
Y1 - 2024/11/15
N2 - 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.
AB - 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.
KW - ANOCA
KW - Coronary pathophysiology
KW - Imaging
KW - Ischemic heart disease
KW - Stable angina
UR - http://www.scopus.com/inward/record.url?scp=85202534172&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2024.132479
DO - 10.1016/j.ijcard.2024.132479
M3 - Article
C2 - 39181410
AN - SCOPUS:85202534172
SN - 0167-5273
VL - 415
JO - International Journal of Cardiology
JF - International Journal of Cardiology
M1 - 132479
ER -