Age-related structural remodelling of the coronary circulation

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions Pub Date : 2024-09-15 DOI:10.1002/ccd.31223

Daniel Faria MD, PhD, Marco Lombardi MD, PhD, Nina van der Hoeven MD, PhD, Alejandro Travieso MD, PhD, Julius C. Heemelaar MD, PhD, Sukhjinder S. Nijjer MD, PhD, Hernán Mejía-Rentería MD, PhD, Guus A. de Waard MD, PhD, Sayan Sen MD, PhD, Tim P. van de Hoef MD, PhD, Ricardo Petraco MD, PhD, Mauro Echavarría-Pinto MD, PhD, Jan J. Piek MD, PhD, Justin E. Davies MD, PhD, Niels van Royen MD, PhD, Javier Escaned MD, PhD

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引用次数: 0

Abstract

Background

While it is broadly accepted that ageing is associated with impairment of coronary microvascular function, little is known about the underlying mechanisms.

Aims

We investigated age-related changes in coronary microvascular structure in patients with stable angina without epicardial coronary stenoses.

Methods

In an analysis of the IDEAL registry, a total of 165 vessels without coronary stenosis were interrogated with combined pressure/Doppler guidewires. We calculated diastolic microvascular conductance (DMVC) and backward expansion wave (BEW), and compared them between age tertiles. We calculated the prevalence of CMD, defined by reduced coronary flow reserve (CFR), and the prevalence of low BEW and low DMVC in each group.

Results

The three study groups were defined as having 37–53, 54–66, and 67–77 years of age, respectively. Oldest (3rd tertile) patients showed lower hyperemic flow velocity (46.7 ± 14.4 vs. 45.1 ± 12.4 vs. 38.4 ± 11.5 cm s⁻¹, p = 0.019), lower DMVC (1.90 ± 0.71 vs. 1.44 ± 0.56 vs. 1.37 ± 0.67 cm s⁻¹ mmHg⁻¹, p < 0.001) and lower BEW intensity (5.9 [2.9–8.4] vs. 4.8 [2.9–6.8] vs. 4.4 [3.4–6.3] × 10⁶ W m⁻² s⁻¹, p = 0.094). Older age was independently associated with lower BEW intensity (B: −0.10, 95% confidence interval [CI]: −0.17 to −0.09, p = 0.021) and DMVC (B: −0.25 95% CI: −0.45 to −0.09, p = 0.027). In patients with CFR < 2.5, the prevalence of BEW intensity and DMVC below the 25th percentile increased with age (25.0% vs. 52.0% vs. 72.7%, p = 0.010).

Conclusions

Ageing is independently associated with structural microcirculatory remodeling that is reflected in BEW intensity and DMVC measurements, and with an increased prevalence of structural CMD. These results are important to understand non-obstructive mechanisms of myocardial ischemia in the elderly.

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与年龄有关的冠状动脉循环结构重塑

虽然人们普遍认为衰老与冠状动脉微血管功能受损有关，但对其潜在机制却知之甚少。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.