Noninvasive visualization of coronary artery endothelial function in healthy subjects and in patients with coronary artery disease
AG Hays, GA Hirsch, S Kelle, G Gerstenblith… - Journal of the American …, 2010 - jacc.org
Journal of the American College of Cardiology, 2010•jacc.org
Objectives: The goal was to test 2 hypotheses: first, that coronary endothelial function can be
measured noninvasively and abnormal function detected using clinical 3.0-T magnetic
resonance imaging (MRI); and second, that the extent of local coronary artery disease
(CAD), in a given patient, is related to the degree of local abnormal coronary endothelial
function. Background: Abnormal endothelial function mediates the initiation and progression
of atherosclerosis and predicts cardiovascular events. However, direct measures of coronary …
measured noninvasively and abnormal function detected using clinical 3.0-T magnetic
resonance imaging (MRI); and second, that the extent of local coronary artery disease
(CAD), in a given patient, is related to the degree of local abnormal coronary endothelial
function. Background: Abnormal endothelial function mediates the initiation and progression
of atherosclerosis and predicts cardiovascular events. However, direct measures of coronary …
Objectives
The goal was to test 2 hypotheses: first, that coronary endothelial function can be measured noninvasively and abnormal function detected using clinical 3.0-T magnetic resonance imaging (MRI); and second, that the extent of local coronary artery disease (CAD), in a given patient, is related to the degree of local abnormal coronary endothelial function.
Background
Abnormal endothelial function mediates the initiation and progression of atherosclerosis and predicts cardiovascular events. However, direct measures of coronary endothelial function have required invasive assessment.
Methods
The MRI was performed in 20 healthy adults and 17 patients with CAD. Cross-sectional coronary area and blood flow were quantified before and during isometric handgrip exercise, an endothelial-dependent stressor. In 10 severe, single-vessel CAD patients, paired endothelial function was measured in the artery with severe stenosis and the contralateral artery with minimal disease.
Results
In healthy adults, coronary arteries dilated and flow increased with stress. In CAD patients, coronary artery area and blood flow decreased with stress (both p ≤ 0.02). In the paired study, coronary artery area and blood flow failed to increase during exercise in the mildly diseased vessel, but both area (p = 0.01) and blood flow (p = 0.02) decreased significantly in the severely diseased, contralateral artery.
Conclusions
Endothelial-dependent coronary artery dilation and increased blood flow in healthy subjects, and their absence in CAD patients, can now be directly visualized and quantified noninvasively. Local coronary endothelial function differs between severely and mildly diseased arteries in a given CAD patient. This novel, safe method may offer new insights regarding the importance of local coronary endothelial function and improved risk stratification in patients at risk for and with known CAD.
jacc.org