P1759Association of endothelial dysfunction and remodeling of large and small vessels with biological markers level in coronary artery disease and microvascular angina patients

Abstract

Aim of the study: To estimate structure and function of large and small vessels in patients with coronary heart disease including patients with diabetes mellitus and microvascular angina and to analyze the association of biological markers levels with macro‐ and microcirculation alterations. Methods: Sixty patients with ischemic heart disease (IHD) were investigated and divided into 2 groups: patients with coronary artery disease (CAD, men‐11; average age 65,31±7,22; average BMI ‐ 28,95±5,19 kg/sqm) and 30 CAD patients with diabetes mellitus (CAD+DM, men‐15; average age 65,9±8,1; average BMI ‐31,9±5,56 kg/sqm). Twenty four patients (40%) had history of myocardial infarction. It was determined after coronaroangiography, that 22 patients (33%) had microvascular angina (MVA). Microcirculation was assessed by photoplethysmography (occlusion index (IO) and skin video capillaroscopy (capillary densities (CD, cap/sq.mm), CD after reactive hyperemia test (CDrh, cap/sq.mm) and CD after venous occlusion (CDvo, cap/sq.mm). Endothelial function and remodeling of large vessels of (stiffness index (SI, m/s); phase shift (PS, ms) were evaluated. Biological markers levels (NT‐proBNP, MMP‐9) were measured. Results: Reduction of CD 38.96 cap/sq.mm (32.08; 51.14), CDrh 42.29 cap/sq.mm (33.15; 54.67) and CDvo 49.17 cap/sq.mm (41.28; 57.08) in all patients was determined. Remodeling of small vessels significant differed between CAD group (CDvo 44.29±3.2 cap/sq.mm) vs. CAD+DM group (CDvo 53.53±2.66 cap/sq.mm; p=0.03). It was found that all patients had structural and functional changes of large and small vessels: increase of SI 8.65 m/s (7; 10.75), decrease of PS 6.6 ms (3.8; 11.7) and IO 1.5 (1.3; 1.7). The data showed significant differences in MMP‐9 level between 2 groups (246.21±14.7 vs. 201.82±13.95; p=0.033). The positive correlation of MMP‐9 level with CDvo (r=‐0,314; p<0,05) and correlation of NT‐proBNP with CDrh (r=‐0,341; p<0,05) were revealed. It was found that CD is significantly less in patients with MVA (35.33±3.37) vs. CAD patients (43.88±2.27; p=0,048). MMP‐9 level was significantly higher in patients with MVA (253±18.12) vs. CAD patients (208.87±12.31; p=0,048). Conclusion: This data revealed that patients with IHD had endothelial dysfunction and remodeling of large and small vessels. CAD patients with diabetes mellitus and without had different levels of MMP‐9 and capillary density. The positive correlation of MMP‐9 level with CDvo and negative correlation of NT‐proBNP with CDrh were revealed. It was found that CD is significantly less in patients with MVA, however MMP‐9 level is higher.