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Coronary microvascular dysfunction in patients with acute coronary syndrome and no obstructive coronary artery disease

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Abstract

Background

Between 10 and 15% of patients admitted for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) show no obstructive coronary artery disease (NO-CAD) at angiography. Coronary microvascular spasm is a possible mechanism of the syndrome, but there are scarce data about coronary microvascular function in these patients.

Objectives

To assess coronary microvascular function in patients with NSTE-ACS and NO-CAD.

Methods

We studied 30 patients (67 ± 10 years, 19 female) with NSTE-ACS and NO-CAD. Specific causes of NSTE-ACS presentation (e.g., variant angina, takotsubo disease, tachyarrhythmias, etc.) were excluded. Coronary blood flow (CBF) velocity response to IV ergonovine (6 µg/kg up to a maximal dose of 400 µg) was evaluated before discharge by transthoracic Doppler echocardiography. CBF response to IV adenosine (140 μg/kg/min) and cold pressor test (CPT) was also assessed after 1 month. Ten age- and sex-matched patients with non-cardiac chest pain served as controls. Vasoactive tests were repeated after 12 months in 10 NSTE-ACS patients.

Results

The ergonovine/basal CBF velocity ratio was 0.79 ± 0.09 and 0.99 ± 0.01 in patients and controls, respectively (p < 0.001). The adenosine/basal CBF velocity ratio was 1.46 ± 0.2 and 3.25 ± 1.2 in patients and controls, respectively (p < 0.001), and the CPT/basal CBF velocity ratio was 1.36 ± 0.2 and 2.43 ± 0.3 in the 2 groups, respectively (p < 0.001). In 10 patients assessed after 12 months, CBF velocity responses to ergonovine, adenosine, and CPT were found to be unchanged.

Conclusions

Patients with NSTE-ACS and NO-CAD exhibit a significant coronary dysfunction, which seems to involve both an increased constrictor reactivity, likely mainly involving coronary microcirculation, and a reduced microvascular dilator function, both persisting at 12-month follow-up.

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Authors and Affiliations

  1. Department of Cardiovascular Disease, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Cardiologia, Largo A. Gemelli, 8, 00168, Rome, Italy

    Antonio De Vita, Laura Manfredonia, Priscilla Lamendola, Angelo Villano, Salvatore Emanuele Ravenna, Antonio Bisignani, Giampaolo Niccoli, Gaetano Antonio Lanza & Filippo Crea

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  1. Antonio De Vita
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  2. Laura Manfredonia
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  3. Priscilla Lamendola
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Correspondence to Gaetano Antonio Lanza.

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De Vita, A., Manfredonia, L., Lamendola, P. et al. Coronary microvascular dysfunction in patients with acute coronary syndrome and no obstructive coronary artery disease. Clin Res Cardiol 108, 1364–1370 (2019). https://doi.org/10.1007/s00392-019-01472-4

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