Peripheral Microvascular Function Reflects Coronary Vascular Function

• Type of Material: Article
• Authors: Ahmed Al-Badri, Emory University; Jeong Hwan Kim, Emory University; Chang Liu, Emory University; Puja Mehta, Emory University; Arshed Quyyumi, Emory University
• Language: English
• Date: 2019-07-01
• Publisher: Lippincott Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 American Heart Association, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1161/ATVBAHA.119.312378
• Title of Journal or Parent Work: Arteriosclerosis, Thrombosis, and Vascular Biology
• Volume: 39
• Issue: 7
• Start Page: 1492
• End Page: 1500
• Grant/Funding Information: Arshed A. Quyyumi is currently supported by National Institutes of Health (NIH) grants 5P01HL101398-02, 1P20HL113451-01, 1R56HL126558-01, 1RF1AG051633-01, R01 NS064162-01, R01 HL89650-01, HL095479-01, 1U10HL110302-01, 1DP3DK094346-01, and 2P01HL086773-06A1.; Ahmed Al-Badri is supported by American Heart Association Postdoctoral Fellowship Award Grant (18POST34080330).
• Keywords: Oxidative stress; acetylcholine; Life Sciences & Biomedicine; vascular resistance; nitroprusside; Chest pain; Science & Technology; endothelium; Risk factors; Hyperpolarizing factor; Smooth muscle; Cardiovascular System & Cardiology; Peripheral Vascular Disease; blood flow velocity; Blood flow; Flow reserve; Angina pectoris; Nitric oxide activity; Endothelium dependent vasodilation; Hematology
• Research Categories: Biology, Microbiology; Health Sciences, Medicine and Surgery; Health Sciences, Pathology

Abstract

Background Coronary endothelial dysfunction is a precursor of atherosclerosis and adverse outcomes. Whether endothelial dysfunction is a localized or generalized phenomenon in humans remains uncertain. Objectives We simultaneously measured femoral and coronary vascular function with the hypothesis that peripheral vascular endothelial function will be reflective of coronary endothelial function. Approach and Results Eighty-five subjects underwent coronary angiography for evaluation of chest pain or abnormal stress tests. Endothelium-dependent and -independent vascular function were measured using intra-coronary and intra-femoral infusions of acetylcholine and sodium nitroprusside, respectively. Coronary flow reserve was assessed using intra-coronary adenosine infusion. Flow velocity was measured in each circulation using a Doppler wire (FloWire, EndoSonics). Coronary vascular resistance (CVR) and femoral vascular resistance (FVR) were calculated as mean arterial pressure (mmHg)/coronary blood flow (ml/min) and mean arterial pressure (mmHg)/femoral average peak velocity (cm/s), respectively. Mean age was 53±11 years, 37% female, 44% hypertensive, 12% diabetic and 38% had obstructive coronary artery disease. There was a correlation between the change in FVR with acetylcholine and acetylcholine-mediated changes in both the CVR (r=0.27; p=0.014) and in the epicardial coronary artery diameter (r=−0.25; p=0.021), indicating that subjects with normal endothelial function in the femoral circulation had normal endothelial function in the coronary epicardial and microcirculation, and vice versa. The coronary vasodilator response to adenosine also correlated with the femoral vasodilatation with acetylcholine (r=0.4; p=0.0002). There was no correlation between the coronary and femoral responses to sodium nitroprusside. Conclusions Endothelial functional changes in the peripheral and coronary circulations were modestly correlated. Thus, peripheral microvascular endothelial function reflects endothelium-dependent coronary epicardial and microvascular function, and the coronary flow reserve.