Caroline Jaarsma1, Hans Vink2, Judith van Haare2, Sebastiaan C A M Bekkers3, Bart D van Rooijen4, Walter H Backes4, Joachim E Wildberger5, Harry J Crijns6, Jurgen van Teeffelen2, Simon Schalla7. 1. Department of Cardiology, Maastricht University Medical Center, The Netherlands. 2. Department of Physiology, Maastricht University, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands. 3. Department of Cardiology, Maastricht University Medical Center, The Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands. 4. Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, The Netherlands. 5. Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands. 6. Department of Cardiology, Maastricht University Medical Center, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands. 7. Department of Cardiology, Maastricht University Medical Center, The Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands. Electronic address: s.schalla@mumc.nl.
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 13 MVA patients (angina pectoris, ST-depression on treadmill testing, normal coronary angiogram) and compared with 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 13 MVA patients, adenosine stress CMR perfusion imaging was performed. Although a significant increase in myocardial perfusion was observed in both the subendocardium and 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.
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 13 MVApatients (angina pectoris, ST-depression on treadmill testing, normal coronary angiogram) and compared with 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 MVApatients 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 13 MVApatients, adenosine stress CMR perfusion imaging was performed. Although a significant increase in myocardial perfusion was observed in both the subendocardium and 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.
Authors: F Groepenhoff; R G M Klaassen; G B Valstar; S H Bots; N C Onland-Moret; H M Den Ruijter; T Leiner; A L M Eikendal Journal: BMC Med Imaging Date: 2021-01-06 Impact factor: 1.930
Authors: Thomas J Ford; David Corcoran; Sandosh Padmanabhan; Alisha Aman; Paul Rocchiccioli; Richard Good; Margaret McEntegart; Janet J Maguire; Stuart Watkins; Hany Eteiba; Aadil Shaukat; Mitchell Lindsay; Keith Robertson; Stuart Hood; Ross McGeoch; Robert McDade; Eric Yii; Naveed Sattar; Li-Yueh Hsu; Andrew E Arai; Keith G Oldroyd; Rhian M Touyz; Anthony P Davenport; Colin Berry Journal: Eur Heart J Date: 2020-09-07 Impact factor: 35.855