Abstract
In the last years, a substantial contribution of red blood cells (RBCs) in cardiovascular homeostasis has been evidenced, as these cells are able to regulate cardiovascular function by the export of adenosine triphosphate and nitric oxide as well as to maintain redox balance through a well-developed antioxidant system. Recently a link between high-risk plaque (HRP) features and myocardial ischemia, in the absence of severe lumen stenosis, has been evidenced. Nonobstructive coronary artery disease (nonob CAD) has been associated in fact with a greater 1-year risk of myocardial infarction and all-cause mortality compared with no apparent CAD. This new evidence increases interest in searching new triggers to identify these high-risk patients, in the absence/or on top of traditional hazard markers. In this study, we investigated the existence of any association between RBC morphodynamics and HRP features in individuals with different grades of coronary stenosis detected by coronary computed tomography angiography (CCTA). Ninety-one consecutive individuals who underwent CCTA [33 no CAD; 26 nonobstructive (nonob), and 32 obstructive (ob) CAD] were enrolled. RBC morphodynamic features, i.e., RBC aggregability and deformability, were analyzed by means of Laser Assisted Optical Rotation Cell Analyzer (LoRRca MaxSis). The putative global RBC morphodynamic (RMD) score and the related risk chart, associating the extent of HRP (e.g., the non-calcified plaque volume) with both the RMD score and the max % stenosis were computed. In nonob CAD group only positive correlations between RBC rigidity, osmotic fragility or aggregability and HRP features (plaque necrotic core, fibro-fatty and fibro-fatty plus necrotic core plaque volumes) were highlighted. Interestingly, in this patient cohort three of these RBC morphodynamic features result to be independent predictors of the presence of non-calcified plaque volume in this patients group. The risk chart created shows that only in nonob CAD plaque vulnerability increases according to the score quartile. Findings of this work, by evidencing the association between erythrocyte morphodynamic characteristics assessed by LoRRca and plaque instability in a high-risk cohort of nonob CAD, suggest the use of these blood cell features in the identification of high-risk patients, in the absence of severe coronary stenosis.
Highlights
Coronary artery disease (CAD) is one of the major causes of morbidity and mortality in the western countries (Montalescot et al, 2013)
We investigated the morphodynamic features of erythrocytes of individuals with different grades of coronary stenosis by means of Laser Assisted Optical Rotational Cell Analyzer (LoRRca MaxSis) in order to find any association between red blood cells (RBCs) features and plaque characteristics
Both ob and nonob CAD patients showed higher mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) values compared to no CAD individuals
Summary
Coronary artery disease (CAD) is one of the major causes of morbidity and mortality in the western countries (Montalescot et al, 2013). Specific anatomic plaque features have been established as fundamental to the process leading to acute coronary thrombosis and, among them, plaque burden, thin-cap fibroatheroma, positive arterial remodeling, necrotic cores, spotty calcifications, and macrophage infiltration play a central role (Virmani et al, 2006). The diagnosis of obstructive (ob) CAD is the milestone for risk stratification in cardiac disease, non-obstructive (nonob) CAD is a relatively common feature, occurring in 10–25% of patients undergoing coronary angiography (Bugiardini and Bairey Merz, 2005), and its presence has been defined as “insignificant” or “no significant CAD” in the medical literature so far (Hung and Cherng, 2003; Patel et al, 2006). Coronary computed tomography angiography (CCTA) has emerged as a non-invasive method for accurate detection and/or exclusion of the presence of CAD (Al-Mallah et al, 2015). As before the “CCTA era” patients with nonob CAD and without signs of inducible ischemia were included in the same group of those without evident disease, with the aid of this imaging technique, we are able, in this patient group, to discriminate between individuals with low-risk plaque morphology and subjects in whom plaque characteristics are associated with an increased risk of future events (Libby, 2013; Conte et al, 2017)
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