Coronary Vascular Function and Cardiomyocyte Injury A Report From the WISE-CVD

• Authors: Ahmed AlBadri, Emory University; Janet Wei, Cedars Sinai Smidt Heart Institute; Odayme Quesada, Cedars Sinai Smidt Heart Institute; Puja Mehta, Emory University; Yi Xiao, Emory University; Yi-An Ko, Emory University; R. David Anderson, University of Florida; John Petersen, University of Florida; Babak Azarbal, Cedars Sinai Smidt Heart Institute; Bruce Samuels, Cedars Sinai Smidt Heart Institute; Timothy D. Henry, Cedars Sinai Smidt Heart Institute; Galen Cook-Wiens, Cedars Sinai Medical Center; Elieen M. Handberg, University of Florida; Jennifer Van Eyk, Cedars Sinai Smidt Heart Institute; Carl J. Pepine, University of Florida; C. Noel Bairey Merz, Cedars Sinai Smidt Heart Institute
• Journal Title: ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY
• Volume: Volume 40, Number 12
• Publisher: LIPPINCOTT WILLIAMS & WILKINS | 2020-12-01, Pages 3015-3021
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1161/ATVBAHA.120.314260
• Subjects: Health Sciences, General; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Hematology; Peripheral Vascular Disease; Cardiovascular System & Cardiology; acetylcholine; cardiomyocyte injury; coronary artery disease; INOCA; myocardial ischemia; risk; troponin I; vascular function; ENDOTHELIUM-DEPENDENT VASODILATION; ARTERY-DISEASE; MICROVASCULAR DYSFUNCTION; NATIONAL-HEART; CHEST-PAIN; TROPONIN-I; CARDIOVASCULAR EVENTS; MYOCARDIAL-INFARCTION; SENSITIVE ASSAY; ISCHEMIA

Abstract

Objective: Women with symptoms or signs of myocardial ischemia but no obstructive coronary artery disease (INOCA) often have coronary vascular dysfunction and elevated risk for adverse cardiovascular events. We hypothesized that u-hscTnI (ultra-high-sensitivity cardiac troponin I), a sensitive indicator of ischemic cardiomyocyte injury, is associated with coronary vascular dysfunction in women with INOCA. Approach and Results: Women (N=263) with INOCA enrolled in the WISE-CVD study (Women's Ischemic Syndrome Evaluation-Coronary Vascular Dysfunction) underwent invasive coronary vascular function testing and u-hscTnI measurements (Simoa HD-1 Analyzer; Quanterix Corporation, Lexington, MA). Logistic regression models, adjusted for traditional cardiovascular risk factors were used to evaluate associations between u-hscTnI and coronary vascular function. Women with coronary vascular dysfunction (microvascular constriction and limited coronary epicardial dilation) had higher plasma u-hscTnI levels (both P=0.001). u-hscTnI levels were associated with microvascular constriction (odds ratio, 1.38 per doubling of u-hscTnI [95% CI, 1.03-1.84]; P=0.033) and limited coronary epicardial dilation (odds ratio, 1.37 per doubling of u-hscTnI [95% CI, 1.04-1.81]; P=0.026). u-hscTnI levels were not associated with microvascular dilation or coronary epicardial constriction. Conclusions: Our findings indicate that higher u-hscTnI is associated with coronary vascular dysfunction in women with INOCA. This suggests that ischemic cardiomyocyte injury in the setting of coronary vascular dysfunction has the potential to contribute to adverse cardiovascular outcomes observed in these women. Additional studies are needed to confirm and investigate mechanisms underlying these findings in INOCA. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00832702.