Assessment of hemodynamic indices of conjunctival microvascular function in patients with coronary microvascular dysfunction
Copyright © 2023 Elsevier Inc. All rights reserved..
OBJECTIVE: Coronary microvascular dysfunction (CMD) is a cause of ischaemia with non-obstructive coronary arteries (INOCA). It is notoriously underdiagnosed due to the need for invasive microvascular function testing. We hypothesized that systemic microvascular dysfunction could be demonstrated non-invasively in the microcirculation of the bulbar conjunctiva in patients with CMD.
METHODS: Patients undergoing coronary angiography for the investigation of chest pain or dyspnoea, with physiologically insignificant epicardial disease (fractional flow reserve ≥0.80) were recruited. All patients underwent invasive coronary microvascular function testing. We compared a cohort of patients with evidence of CMD (IMR ≥25 or CFR <2.0); to a group of controls (IMR <25 and CFR ≥2.0). Conjunctival imaging was performed using a previously validated combination of a smartphone and slit-lamp biomicroscope. This technique allows measurement of vessel diameter and other indices of microvascular function by tracking erythrocyte motion.
RESULTS: A total of 111 patients were included (43 CMD and 68 controls). There were no differences in baseline demographics, co-morbidities or epicardial coronary disease severity. The mean number of vessel segments analysed per patient was 21.0 ± 12.8 (3.2 ± 3.5 arterioles and 14.8 ± 10.8 venules). In the CMD cohort, significant reductions were observed in axial/cross-sectional velocity, blood flow, wall shear rate and stress.
CONCLUSION: The changes in microvascular function linked to CMD can be observed non-invasively in the bulbar conjunctiva. Conjunctival vascular imaging may have utility as a non-invasive tool to both diagnose CMD and augment conventional cardiovascular risk assessment.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:147 |
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| Enthalten in: |
Microvascular research - 147(2023) vom: 20. Mai, Seite 104480 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Mailey, Jonathan A [VerfasserIn] |
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| Links: |
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| Themen: |
Cardiovascular screening |
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| Anmerkungen: |
Date Completed 14.03.2023 Date Revised 16.03.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.mvr.2023.104480 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM352009527 |
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| 500 | |a Date Revised 16.03.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 Elsevier Inc. All rights reserved. | ||
| 520 | |a OBJECTIVE: Coronary microvascular dysfunction (CMD) is a cause of ischaemia with non-obstructive coronary arteries (INOCA). It is notoriously underdiagnosed due to the need for invasive microvascular function testing. We hypothesized that systemic microvascular dysfunction could be demonstrated non-invasively in the microcirculation of the bulbar conjunctiva in patients with CMD | ||
| 520 | |a METHODS: Patients undergoing coronary angiography for the investigation of chest pain or dyspnoea, with physiologically insignificant epicardial disease (fractional flow reserve ≥0.80) were recruited. All patients underwent invasive coronary microvascular function testing. We compared a cohort of patients with evidence of CMD (IMR ≥25 or CFR <2.0); to a group of controls (IMR <25 and CFR ≥2.0). Conjunctival imaging was performed using a previously validated combination of a smartphone and slit-lamp biomicroscope. This technique allows measurement of vessel diameter and other indices of microvascular function by tracking erythrocyte motion | ||
| 520 | |a RESULTS: A total of 111 patients were included (43 CMD and 68 controls). There were no differences in baseline demographics, co-morbidities or epicardial coronary disease severity. The mean number of vessel segments analysed per patient was 21.0 ± 12.8 (3.2 ± 3.5 arterioles and 14.8 ± 10.8 venules). In the CMD cohort, significant reductions were observed in axial/cross-sectional velocity, blood flow, wall shear rate and stress | ||
| 520 | |a CONCLUSION: The changes in microvascular function linked to CMD can be observed non-invasively in the bulbar conjunctiva. Conjunctival vascular imaging may have utility as a non-invasive tool to both diagnose CMD and augment conventional cardiovascular risk assessment | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Cardiovascular screening | |
| 650 | 4 | |a Conjunctiva | |
| 650 | 4 | |a INOCA | |
| 650 | 4 | |a Microvascular angina | |
| 650 | 4 | |a Microvascular dysfunction | |
| 700 | 1 | |a Moore, Julie S |e verfasserin |4 aut | |
| 700 | 1 | |a Brennan, Paul F |e verfasserin |4 aut | |
| 700 | 1 | |a Jing, Min |e verfasserin |4 aut | |
| 700 | 1 | |a Awuah, Agnes |e verfasserin |4 aut | |
| 700 | 1 | |a McLaughlin, James A D |e verfasserin |4 aut | |
| 700 | 1 | |a Nesbit, M Andrew |e verfasserin |4 aut | |
| 700 | 1 | |a Moore, Tara C B |e verfasserin |4 aut | |
| 700 | 1 | |a Spence, Mark S |e verfasserin |4 aut | |
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