BACKGROUND:In patients with ischemia and no obstructive coronary artery disease (INOCA), coronary microvascular dysfunction is associated with higher rate of major adverse cardiovascular events. OBJECTIVE:To demonstrate if microvascular dysfunction present in coronary microcirculation of patients with INOCA may be detected noninvasively in their peripheral circulation. METHODS:25 patients with INOCA and 25 apparently healthy individuals (controls) were subjected to nailfold videocapillaroscopy (NVC) and venous occlusion plethysmography (VOP) to evaluate peripheral microvascular function and blood collection for biomarkers analysis, including soluble vascular cell adhesion molecule-1 (sVCAM-1), endothelin-1 (ET-1) and C-reactive protein (CRP). RESULTS:Red blood cell velocity (RBCV) before and after ischemia (RBCVmax) were significantly lower in patients with INOCA (p = 0.0001). Time to reach maximal red blood cell velocity (TRBCVmax) was significantly longer in INOCA group (p = 0.0004). Concerning VOP, maximal blood flow (p = 0.004) and its relative increment were significantly lower in patients with INOCA (p = 0.0004). RBCVmax showed significant correlations with sVCAM-1 (r = –0.38, p < 0.05), ET-1 (r = –0.73, p < 0.05) and CRP (r = –0.33, p < 0.05). Relative increment of maximal post-ischemic blood flow was significantly correlated with sVCAM-1 (r = –0.42, p < 0.05) and ET-1 (r = –0.48, p < 0.05). CONCLUSIONS:The impairment of microvascular function present in coronary microcirculation of patients with INOCA can be also detected in peripheral microcirculation.

中文翻译：

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缺血且无阻塞性冠状动脉疾病 (INOCA) 的患者也存在外周微血管功能障碍

背景：在缺血且无阻塞性冠状动脉疾病 (INOCA) 的患者中，冠状动脉微血管功能障碍与主要不良心血管事件的发生率较高有关。目的：证明是否可以在 INOCA 患者的外周循环中无创地检测到其冠状动脉微循环中存在的微血管功能障碍。方法：对 25 名 INOCA 患者和 25 名明显健康的个体（对照组）进行甲襞视频毛细血管镜检查（NVC）和静脉阻塞体积描记术（VOP），以评估外周微血管功能和血液采集以进行生物标志物分析，包括可溶性血管细胞粘附分子-1（ sVCAM-1)、内皮素-1 (ET-1) 和 C 反应蛋白 (CRP)。结果：INOCA 患者缺血前后的红细胞速度 (RBCV) (RBCVmax) 显着降低 (p = 0.0001)。INOCA 组达到最大红细胞速度 (TRBCVmax) 的时间明显更长 (p = 0.0004)。关于 VOP，INOCA 患者的最大血流量 (p = 0.004) 及其相对增量显着较低 (p = 0.0004)。RBCVmax 与 sVCAM-1 (r = –0.38, p < 0.05)、ET-1 (r = –0.73, p < 0.05) 和 CRP (r = –0.33, p < 0.05) 显着相关。最大缺血后血流量的相对增量与 sVCAM-1 (r = –0.42, p < 0.05) 和 ET-1 (r = –0.48, p < 0.05) 显着相关。结论:INOCA患者冠状动脉微循环中存在的微血管功能损害也可在外周微循环中检测到。