Evaluation of the systemic micro- and macrovasculature in stable angina: a case-control study

Neisius, U., Olson, E., Rossi, S. H., Ibrahim, H. A., Currie, G. , Dominiczak, A. and Delles, C. (2017) Evaluation of the systemic micro- and macrovasculature in stable angina: a case-control study. PLoS ONE, 12(5), e0178412. (doi: 10.1371/journal.pone.0178412) (PMID:28542516) (PMCID:PMC5444845)

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Aims: The diagnosis of stable angina involves the use of probability estimates based on clinical presentation, age, gender and cardiovascular risk factors. In view of the link between the cardiac and systemic vasculature we tested whether non-invasive measures of systemic micro- and macrovascular structure and function differentiate between individuals with flow-limiting coronary artery disease (CAD) and those with normal coronary arteries (NCA). Methods and results: We recruited 84 patients undergoing elective coronary angiography for investigation of symptoms of stable angina. Patients were selected for either having significant CAD or NCA (n = 43/41; age, 56±7 vs 57±7 years, P = 0.309). Only microvascular endothelial function, measured using the Endo-PAT2000 device to determine reactive hyperaemia index (CAD vs. NCA; 1.9 [1.5; 2.3] vs. 2.1 [1.8; 2.4], P = 0.03) and sonographic carotid plaque score (CAD vs. NCA; 3.0 [1.5; 4.5] vs. 1.2 [0; 2.55], P<0.001) were significantly different between patients with CAD and NCA. No significant differences were detected in reflection magnitude (CAD vs. NCA; 1.7 [1.5; 1.8] % vs 1.7 [1.5; 1.9] %, P = 0.342), pulse wave velocity (CAD vs. NCA; 7.8±1.4 m/sec vs. 8.3±1.5 m/sec, P = 0.186), carotid intima-media thickness (CAD vs. NCA; 0.73±0.10 mm vs. 0.75±0.10 mm, P = 0.518) or carotid distensibility (CAD vs. NCA; 3.8±1.2 10-3/kPa vs. 3.4±0.9 10-3/kPa, P = 0.092). Also, the c-statistic of the pre-test probability based on history and traditional risk factors (c = 0.665; 95% CI, 0.540–0.789) was improved by the addition of the inverse RHI (c = 0.720; 95% CI, 0.605–0.836), carotid plaque score (c = 0.770, 95% CI, 0.659–0.881), and of both markers in combination (c = 0.801; 95% CI, 0.701–0.900). Conclusion: There are distinct differences in the systemic vasculature between patients with CAD and NCA that may have the potential to guide diagnostic and therapeutic decisions. Carotid artery plaque burden and microvascular function appear to be most promising in this context.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Currie, Dr Gemma and Neisius, Dr Ulf and Dominiczak, Professor Anna and Delles, Professor Christian
Authors: Neisius, U., Olson, E., Rossi, S. H., Ibrahim, H. A., Currie, G., Dominiczak, A., and Delles, C.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:PLoS ONE
Publisher:Public Library of Science
ISSN (Online):1932-6203
Copyright Holders:Copyright © 2017 Neisius et al.
First Published:First published in PLoS ONE 12(5): e0178412
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
617771BHF centre of excellenceRhian TouyzBritish Heart Foundation (BHF)RE/13/5/30177RI CARDIOVASCULAR & MEDICAL SCIENCES
421221InGenious HyperCare - Integrating Genomics, Clinical Research and Care in HypertensionAnna DominiczakEuropean Commission (EC)LSHM-CT-2006-037093RI CARDIOVASCULAR & MEDICAL SCIENCES
557491EU-MASCARA - Biomarkers for Cardiovascular DiseaseChristian DellesEuropean Commission (EC)N/ARI CARDIOVASCULAR & MEDICAL SCIENCES