Disfunción Microvascular Coronaria e Inflamación Crónica. Coronary Microvascular Dysfunction and Chronic Inflammation.
Year: 2018
Type: article
Study design: Observational Study
Abstract: Background. Coronary microvascular dysfunction associated with endothelial dysfunction is often found in many cardiac conditions, including cardiovascular risk factors, and inflammation would be playing a key role in all this epiphenomenon. Actually, atherosclerosis is seen as an active inflammatory and immune-mediated process in which leukocytes and soluble factors (antibodies, activated complement, cytokines) play a role in accelerating vessel pathology. Patients with systemic inflammatory, autoimmune disease, such as rheumatoid arthritis (AR) and systemic lupus erythematosus (SLE), suffer from increased cardiovascular morbidity and mortality owing to accelerated atherosclerosis and premature coronary disease. The excess risk observed in these patients appears to be driven by the damaging effects of systemic inflammation on the vasculature. A low grade of inflammation could also play a role in the pathogenesis of cardiac syndrome X (ie typical angina and transient myocardial ischemia despite normal coronary arteries) in which coronary microvascular dysfunction has been show to lead myocardial ischemia. Aims. To demonstrate that exposure to chronic inflammation results in coronary microvascular dysfunction (CMD). We speculate that the degree of CMD is directly related to time exposed to inflammation and also hypothesise a potential role of inflammation in the modulation of coronary microvascular responses in some patients. Methods. We carried out 2 separated studies in which systemic inflammatory (AR and LES) patients and CSX patients were analyzed by using positron emission tomography. Resting and hyperaemic (adenosine, 140 μg/Kg/min) myocardial blood flow (MBF) was measured in both groups of patients and in matched healthy volunteers as controls. Results. Although resting MBF was similar in patients (AR/LES and CSX) and controls, abnormalities of the coronary microvascular function were found in both studies, with reduced coronary flow reserve (CFR). CSX patients with C reactive protein levels higher of 3 mg/L at study entry had more severe impairment of CFR. In AR/SLE patients, CFR was inversely related to disease duration (r=-0.65; p<0.001). In both groups of patients, we also found that patients showing ischaemic electrocardiographic changes during adenosine induced hyperaemia, had lower CFR and longer disease duration (AR/LES patients) or higher CRP levels (CSX patients) when compared with patients without changes. Conclusions. Chronic inflammation in the absence of significant coronary disease and traditional cardiovascular risk factors is associated with severe abnormalities of coronary microcirculation, and the degree of this CMD is related with the exposure time to inflammation. We suggest a role for inflammation in the modulation of coronary responses in patients with CSX. This may represent an early marker of cardiovascular disease which precedes and contributes to accelerated atherogenesis. 1.- Un estado inflamatorio crónico se correlaciona con la presencia de DMC, aún en ausencia de factores de riesgo cardiovascular y sin enfermedad de las arterias coronarias epicárdicas establecida. 2.- La inflamación sistémica crónica, característica común de las enfermedades autoinmunes sistémicas como la artritis reumatoidea y el lupus eritematoso sistémico, resultará en una DMC cuya intensidad se correlacionará con el tiempo de evolución de la enfermedad. Para contestar esta hipótesis hemos desarrollado el primer trabajo de esta tesis en el que se analizará la función microvascular coronaria de pacientes con AR y LES, sin factores de riesgo cardiovascular y sin lesiones ateroscleróticas de las coronarias epicárdicas. 3.- Un estado proinflamatorio de bajo grado, como el que caracteriza a los pacientes con síndrome X, definido por la presencia de clínica anginosa típica e isquemia miocárdica transitoria con coronarias angiograficamente normales, se correlacionará con DMC. Para testar esta hipótesis, llevamos a cabo el segundo estudio que se presenta en este trabajo. Nos plantemos que aquellos pacientes con niveles más elevados de proteína C reactiva ultrasensible, marcador de inflamación sistémica, presentarán mayor DMC la cual podría modular la aparición de los cambios isquémicos electrocardiográficos que pueden presentar estos pacientes.
Author: Recio Mayoral, Alejandro
Language: English
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W6999818157