Non-invasive assessment of microvascular dysfunction in patients with microvascular angina

Caroline Jaarsma, Hans Vink, Judith van Haare, Sebastiaan C. A. M. Bekkers, Bart D. van Rooijen, Walter H. Backes, Joachim E. Wildberger, Harry J. Crijns, Jurgen van Teeffelen, Simon Schalla*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: We aimed to evaluate the microvascular function in patients with microvascular angina (MVA) by assessing 1) the endothelial glycocalyx barrier properties using sublingual microscopy, and 2) the myocardial perfusion reserve using cardiovascular magnetic resonance (CMR) imaging.

Methods: Sublingual microscopy was performed in 13MVA patients (angina pectoris, ST-depression on treadmill testing, normal coronary angiogram) and comparedwith 2 control groups of 13 volunteers and 14 patients with known obstructive coronary artery disease (CAD). To test the glycocalyx-mediated microvascular responsiveness, the erythrocyte perfused boundary region (PBR) was assessed at baseline and after nitroglycerin challenge.

Results: The baseline PBR of MVA patients was similar to controls with CAD (p = 0.72), and larger than in volunteers (p = 0.02). Only the volunteers demonstrated a significant increase in PBR after nitroglycerin (p = 0.03). In the 13MVA patients, adenosine stress CMR perfusion imaging was performed. Although a significant increase in myocardial perfusion was observed in both the subendocardiumand subepicardium during stress, the subendocardial perfusion reserve was significantly lower (p = 0.02). The PBR responsiveness of the sublingual microvasculature showed a strong correlation with the transmural myocardial perfusion reserve (r = 0.86, p <0.001).

Conclusions: Patients with MVA can be characterized by microvascular glycocalyx dysfunction using sublingual microscopy. The strong correlation between sublingual PBR responsiveness and myocardial perfusion reserve suggests that the glycocalyx may play an important role in the regulation of microvascular volume for myocardial perfusion and supports the concept of impaired glycocalyx barrier properties in MVA. (C) 2017 Elsevier B.V. All rights reserved.

Original languageEnglish
Pages (from-to)433-439
Number of pages7
JournalInternational Journal of Cardiology
Volume248
DOIs
Publication statusPublished - 1 Dec 2017

Keywords

  • Endothelium
  • Imaging
  • Magnetic resonance imaging
  • Microcirculation
  • Syndrome X
  • CARDIAC SYNDROME-X
  • CARDIOVASCULAR MAGNETIC-RESONANCE
  • CORONARY-ARTERY-DISEASE
  • TRANSMURAL MYOCARDIAL-PERFUSION
  • GLYCOCALYX BARRIER PROPERTIES
  • ENDOTHELIAL GLYCOCALYX
  • CHEST-PAIN
  • ISCHEMIA
  • RESERVE
  • FLOW

Cite this
{"cc_re__cc_re__cc_by_4_0": ["class=\"rendering rendering_researchoutput  rendering_researchoutput_publicationaccessrenderer rendering_contributiontojournal rendering_publicationaccessrenderer rendering_contributiontojournal_publicationaccessrenderer\"><ul class=\"dois\"><li class=\"open-access\"><div class=\"doi\"><a onclick=\"window.open(this.href, '_blank','noopener,noreferrer'); return false;\" href=\"https://doi.org/10.1016/j.ijcard.2017.05.010\" class=\"link\"><span>10.1016/j.ijcard.2017.05.010</span></a><span class=\"meta\">Licence: <a onclick=\"window.open(this.href, '_blank','noopener,noreferrer'); return false;\" href=\"http://creativecommons.org/licenses/by/4.0/\" class=\"link\">CC BY</a></span></div></li></ul></div>\n\n                        \n\n                        \n\n                        \n\n                        \n\n                        \n\n\n                    </div>\n                </div>\n            </div>\n        </section>\n        \n\n        \n            \n        \n            \n        \n            \n        \n            \n        \n            \n        \n            \n        \n            \n        \n            \n        \n            \n        \n            \n        \n  "], "copyright__copyright__copyright": ["geEnglish\nPages (from-to)433-439\nNumber of pages7\nJournalInternational Journal of Cardiology\nVolume248\nDOIs\nPublication statusPublished - 1 Dec 2017\n\nKeywords\n\n  \u2022 Endothelium\n  \u2022 Imaging\n  \u2022 Magnetic resonance imaging\n  \u2022 Microcirculation\n  \u2022 Syndrome X\n  \u2022 CARDIAC SYNDROME-X\n  \u2022 CARDIOVASCULAR MAGNETIC-RESONANCE\n  \u2022 CORONARY-ARTERY-DISEASE\n  \u2022 TRANSMURAL MYOCARDIAL-PERFUSION\n  \u2022 GLYCOCALYX BARRIER PROPERTIES\n  \u2022 ENDOTHELIAL GLYCOCALYX\n  \u2022 CHEST-PAIN\n  \u2022 ISCHEMIA\n  \u2022 RESERVE\n  \u2022 FLOW\n\nCite this", "geEnglish\nPages (from-to)433-439\nNumber of pages7\nJournalInternational Journal of Cardiology\nVolume248\nDOIs\nPublication statusPublished - 1 Dec 2017\n\nKeywords\n\n  \u2022 Endothelium\n  \u2022 Imaging\n  \u2022 Magnetic resonance imaging\n  \u2022 Microcirculation\n  \u2022 Syndrome X\n  \u2022 CARDIAC SYNDROME-X\n  \u2022 CARDIOVASCULAR MAGNETIC-RESONANCE\n  \u2022 CORONARY-ARTERY-DISEASE\n  \u2022 TRANSMURAL MYOCARDIAL-PERFUSION\n  \u2022 GLYCOCALYX BARRIER PROPERTIES\n  \u2022 ENDOTHELIAL GLYCOCALYX\n  \u2022 CHEST-PAIN\n  \u2022 ISCHEMIA\n  \u2022 RESERVE\n  \u2022 FLOW\n\nCite this", "geEnglish\nPages (from-to)433-439\nNumber of pages7\nJournalInternational Journal of Cardiology\nVolume248\nDOIs\nPublication statusPublished - 1 Dec 2017\n\nKeywords\n\n  \u2022 Endothelium\n  \u2022 Imaging\n  \u2022 Magnetic resonance imaging\n  \u2022 Microcirculation\n  \u2022 Syndrome X\n  \u2022 CARDIAC SYNDROME-X\n  \u2022 CARDIOVASCULAR MAGNETIC-RESONANCE\n  \u2022 CORONARY-ARTERY-DISEASE\n  \u2022 TRANSMURAL MYOCARDIAL-PERFUSION\n  \u2022 GLYCOCALYX BARRIER PROPERTIES\n  \u2022 ENDOTHELIAL GLYCOCALYX\n  \u2022 CHEST-PAIN\n  \u2022 ISCHEMIA\n  \u2022 RESERVE\n  \u2022 FLOW\n\nCite this", "geEnglish\nPages (from-to)433-439\nNumber of pages7\nJournalInternational Journal of Cardiology\nVolume248\nDOIs\nPublication statusPublished - 1 Dec 2017\n\nKeywords\n\n  \u2022 Endothelium\n  \u2022 Imaging\n  \u2022 Magnetic resonance imaging\n  \u2022 Microcirculation\n  \u2022 Syndrome X\n  \u2022 CARDIAC SYNDROME-X\n  \u2022 CARDIOVASCULAR MAGNETIC-RESONANCE\n  \u2022 CORONARY-ARTERY-DISEASE\n  \u2022 TRANSMURAL MYOCARDIAL-PERFUSION\n  \u2022 GLYCOCALYX BARRIER PROPERTIES\n  \u2022 ENDOTHELIAL GLYCOCALYX\n  \u2022 CHEST-PAIN\n  \u2022 ISCHEMIA\n  \u2022 RESERVE\n  \u2022 FLOW\n\nCite this", "geEnglish\nPages (from-to)433-439\nNumber of pages7\nJournalInternational Journal of Cardiology\nVolume248\nDOIs\nPublication statusPublished - 1 Dec 2017\n\nKeywords\n\n  \u2022 Endothelium\n  \u2022 Imaging\n  \u2022 Magnetic resonance imaging\n  \u2022 Microcirculation\n  \u2022 Syndrome X\n  \u2022 CARDIAC SYNDROME-X\n  \u2022 CARDIOVASCULAR MAGNETIC-RESONANCE\n  \u2022 CORONARY-ARTERY-DISEASE\n  \u2022 TRANSMURAL MYOCARDIAL-PERFUSION\n  \u2022 GLYCOCALYX BARRIER PROPERTIES\n  \u2022 ENDOTHELIAL GLYCOCALYX\n  \u2022 CHEST-PAIN\n  \u2022 ISCHEMIA\n  \u2022 RESERVE\n  \u2022 FLOW\n\nCite this"]}