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Chronic inflammation and coronary microvascular dysfunction in patients without risk factors for coronary artery disease
Abstract
AIMS: To demonstrate that exposure to chronic inflammation results in coronary microvascular dysfunction (CMD). METHODS AND RESULTS: Using positron emission tomography, resting and hyperaemic (adenosine, 140 microg/kg/min) myocardial blood flow (MBF) was measured in 25 patients with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA). Coronary flow reserve (CFR) was calculated as adenosine/resting MBF. Patients had normal or minimally diseased (i.e. <or=20% luminal diameter) coronary arteries at angiography and no cardiovascular risk factors. Twenty five age- and gender-matched healthy volunteers served as controls. Resting MBF was similar in patients and controls (1.25 +/- 0.27 vs. 1.15 +/- 0.24 mL/min/g; P = 0.15) while patients had lower hyperaemic MBF (2.94 +/- 0.83 vs. 4.11 +/- 0.84 mL/min/g; P < 0.001) and CFR (2.44 +/- 0.78 vs. 3.81 +/- 1.07; P < 0.001). CFR was inversely related to disease duration (r = -0.65; P < 0.001) and SLE disease activity (r = -0.69; P = 0.01). Seven patients showed ischaemic electrocardiographic changes during adenosine. They had longer disease duration (21 +/- 7 vs. 14 +/- 5 years; P = 0.03) and lower CFR (1.76 +/- 0.81 vs. 2.49 +/- 0.54; P = 0.006) when compared with patients without changes. CONCLUSION: A reduced CFR in the absence of significant coronary disease is suggestive of CMD. We speculate that this is the consequence of prolonged systemic inflammation, which may precede and contribute to premature coronary artery disease in these patients.
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“Coronary microvascular dysfunction is an early marker of accelerated coronary atherosclerosis and may contribute to the increased cardiovascular morbidity and mortality in these patients.189”
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Metadata
- Authors
- Recio-Mayoral, A., Mason, J. C., Kaski, J. C., Rubens, M. B., Harari, O. A., & Camici, P. G.
- Affiliations
- Imperial College London (GB)
- St George's, University of London (GB)
- Royal Brompton Hospital (GB)
- Corresponding author
- Camici, P. G.
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-06-05
- Volume
- 30
- Issue
- 15
- Pages
- 1837-1843
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2021794274
- Cited by
- 235
- References
- 50
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 15 · 2023: 11 · 2022: 14 · 2021: 28 · 2020: 15 · 2019: 14 · 2018: 14 · 2017: 11 · 2016: 13 · 2015: 20 · 2014: 12 · 2013: 11 · 2012: 17
- FWCI
- 8.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Sociedad Española de Cardiología
- Cardiovascular Research Foundation
- National Institute for Health and Care Research
- British Heart Foundation (PG/08001)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
- Keywords
- chronic inflammation, coronary microvascular dysfunction, coronary flow reserve, systemic lupus erythematosus, rheumatoid arthritis, myocardial blood flow, disease duration, disease activity, myocardial ischemia, premature coronary artery disease
- MeSH terms
- Adenosine, Adult, Arthritis, Rheumatoid, Coronary Artery Disease, Coronary Circulation, Endothelium, Vascular, Female, Humans, Inflammation, Lupus Erythematosus, Systemic, Male, Microcirculation, Prospective Studies, Vasodilator Agents, Case-Control Studies, Risk Assessment, Positron-Emission Tomography, Fractional Flow Reserve, Myocardial
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