Abstract
Coronary microvascular dysfunction (MVD) is a syndrome of abnormal regulation of vascular tone, particularly during increased metabolic demand. While there are several risk factors for MVD, some of which are similar to those for coronary artery disease (CAD), the cause of MVD is not understood. We hypothesized that MVD in symptomatic non-elderly subjects would be characterized by specific lipidomic profiles. Subjects (n = 20) aged 35–60 years and referred for computed tomography coronary angiography (CTA) for chest pain but who lacked obstructive CAD (>50% stenosis), underwent quantitative regadenoson stress-rest myocardial contrast echocardiography (MCE) perfusion imaging for MVD assessment. The presence of MVD defined by kinetic analysis of MCE data was correlated with lipidomic profiles in plasma measured by liquid chromatography and high-resolution mass spectrometry. Nine of twenty subjects had evidence of MVD, defined by reduced hyperemic perfusion versus other subjects (beta-value 1.62 ± 0.44 vs. 2.63 ± 0.99 s−1, p = 0.009). Neither the presence of high-risk but non-obstructive CAD on CTA, nor CAD risk factors were different for those with versus without MVD. Lipidomic analysis revealed that patients with MVD had lower concentrations of long-carbon chain triacylglycerols and diacylglycerols, and higher concentrations of short-chain triacylglycerols. The diacylglycerol containing stearic and linoleic acid classified all participants correctly. We conclude that specific lipidomic plasma profiles occur in MVD involving saturated long-chain fatty acid-containing acylglycerols that are distinctly different from those in non-obstructive CAD. These patterns could be used to better characterize the pathobiology and potential treatments for this condition.
Highlights
The left ventricular myocardium is in a constant state of high metabolic demand
C, fatty acid carbon chain length; 95% CI, 95% confidence interval; DAG, diacylglycerol; MVD, microvascular dysfunction; AUC of ROC-value, area under the curve of receiver operating characteristic; TAG, triacylglycerol
MVD reflects an imbalance of vasoconstrictor and vasodilator processes that govern microvascular resistance under different physiologic states, commonly resulting in reduced peak hyperemic flow response [3,4]
Summary
The left ventricular myocardium is in a constant state of high metabolic demand. Yet, the working myocyte contains only a small amount of high-energy phosphate reserves [1].adequate tissue perfusion is essential for the constant delivery of oxygen and high-energy fuels including fatty acids (FA), glucose, amino acids and ketones; and oxygen for high-efficiency oxidative generation of myocellular adenosine triphosphate (ATP) [2].Myocardial perfusion can be compromised by a spectrum of diseases, including obstructive coronary artery disease (CAD) and microvascular dysfunction (MVD). The left ventricular myocardium is in a constant state of high metabolic demand. Adequate tissue perfusion is essential for the constant delivery of oxygen and high-energy fuels including fatty acids (FA), glucose, amino acids and ketones; and oxygen for high-efficiency oxidative generation of myocellular adenosine triphosphate (ATP) [2]. Myocardial perfusion can be compromised by a spectrum of diseases, including obstructive coronary artery disease (CAD) and microvascular dysfunction (MVD). The latter is usually defined by conditions of abnormal tone in the microvessels that regulate coronary resistance and match perfusion to metabolic demand [3,4]. Because of the critical role of the microcirculation in normal cardiac function, those with MVD have a long-term prognosis similar to that of patients with stable CAD [5,6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
