Coronary microvascular dysfunction in chronic inflammatory rheumatoid diseases

Faccini, Alessia; Kaski, Juan Carlos; Camici, Paolo G.

doi:10.1093/eurheartj/ehw018

Cited by 104 publications

(52 citation statements)

References 109 publications

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“…While this is important for acute MI development or ischemic strokes, numerous chronic conditions are associated with microvascular dysfunction, which may be a key mechanism for heart failure development, cognitive impairment and vascular dementia 30,31 . Moreover, it has been reported that microvascular dysfunction may lead to CV events even in the absence of obstructive epicardial coronary artery disease 32 . Therefore, identification of profoundly impaired microvascular flow mediated endothelial function and abnormalities within microvessel morphology may have numerous long term clinical consequences.…”

Section: Discussionmentioning

confidence: 99%

Microvascular dysfunction in ankylosing spondylitis is associated with disease activity and is improved by anti-TNF treatment

Batko¹,

Maga

Urbański

et al. 2018

Sci Rep

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Ankylosing spondylitis (AS) is associated with high cardiovascular morbidity and mortality. Recent studies indicate that microvascular dysfunction may underlie cardiovascular risk in AS. We hypothesized, that microvascular morphology and dysfunction is linked to AS activity and is modifiable by TNF-α inhibitor (TNFi) treatment. Functional Laser Doppler Flowmetry with post-occlusive reactive hyperemia, and structural nailfold capillaroscopy were performed in 54 patients with AS and 28 matched controls. Active AS was diagnosed based on BASDAI ≥ 4 (n = 37). Effects of 3-month TNFi on microcirculation in active AS were studied. AS was associated with prolonged time to peak hyperemia compared to healthy controls. High disease activity was associated with increased time to peak hyperemia and decreased peak hyperemia when compared to patients with inactive AS. In capillaroscopy, AS was associated with morphological abnormalities indicating increased neoangiogenesis and pericapillary edema compared to controls. Microvascular function improved following 3 months of TNFi in reference to basal flow as well as post-occlusive parameters. TNFi reduced pericapillary edema, while other parameters of capillary morphology remained unchanged. Microvascular dysfunction and capillary neovascular formation are associated with disease activity of AS. Anti-TNF-α treatment may restore microcirculation function and capillary edema but does not modify microvascular structural parameters.

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Section: Discussionmentioning

confidence: 99%

Microvascular dysfunction in ankylosing spondylitis is associated with disease activity and is improved by anti-TNF treatment

Batko¹,

Maga

Urbański

et al. 2018

Sci Rep

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“…(19) Cardiac positron-emission tomography (PET) has revealed impaired microvascular blood flow and reduced coronary flow reserve in SLE patients. (20)**…”

Section: Endothelial Dysfunction and Aberrant Metabolic Pathways In Slementioning

confidence: 99%

Update on cardiovascular disease in lupus

Lewandowski

Kaplan

2016

Current Opinion in Rheumatology

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Purpose of Review Atherosclerotic cardiovascular disease confers significant morbidity and mortality in patients with systemic lupus erythematosus (SLE) and cannot be fully explained by traditional cardiovascular risk factors. Recent immunologic discoveries have outlined putative pathways in SLE that may also accelerate the development of atherosclerosis. Recent findings Aberrant innate and adaptive immune responses implicated in lupus pathogenesis may also contribute to the development of accelerated atherosclerosis in these patients. Defective apoptosis, abnormal lipoprotein function, autoantibodies, aberrant neutrophil responses and a dysregulated type I interferon pathway likely contribute to endothelial dysfunction. SLE macrophages have an inflammatory phenotype that may drive progression of plaque. Summary Recent discoveries have placed increase emphasis on the immunology of atherosclerotic cardiovascular disease. Understanding the factors that drive the increase risk for CVD in SLE patients may provide selective therapeutic targets for reducing inflammation and improving outcomes in atherosclerosis.

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“…Stress Myocardial Perfusion Scintigraphy (MPS) is a non-invasive imaging modality used in patients with suspected CAD, commonly found in RA and SLE [68]. However, MPS has serious limitations including radiation exposure, imaging artefacts and low spatial resolution, which do not permit detection of subendocardial ischemia and small scars seen in ARD [69].…”

Section: Cardiovascular Diagnosis In the Era Of Multimodality Imagingmentioning

confidence: 99%

The Sphinx’s riddle: cardiovascular involvement in autoimmune rheumatic disease

Mavrogeni

Markousis‐Mavrogenis

Kolovou

2016

BMC Cardiovasc Disord

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Factors leading to Cardiovascular Disease (CVD) in Autoimmune Rheumatic Diseases (ARD) include: a) atherosclerosis and macro-microvascular coronary artery disease b) pericardial, myocardial and vascular inflammation c) heart valve disease d) heart failure and e) pulmonary hypertension.Cardiology utilizes various non-invasive imaging modalities, such as rest/stress Electrocardiogram (ECG), echocardiography, nuclear imaging and more recently Cardiovascular Magnetic Resonance (CMR) to detect ischemic or inflammatory disease in ARD. Exercise ECG is a reliable prognostic test for identification of patients either very unlikely or very likely to have cardiac events. However, this is not the case for intermediate risk patients. In stress echocardiography the diagnostic end point for the detection of myocardial ischemia is the induction of a transient worsening in regional function during stress. It provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion, but at a lower cost and without radiation exposure. Stress Myocardial Perfusion Scintigraphy (MPS) is a non-invasive imaging modality for patients with suspected coronary artery disease, but has important limitations including radiation exposure, imaging artefacts and low spatial resolution, which preclude detection of small myocardial scars commonly found in ARD. By identifying early stages of inflammation and perfusion defects, CMR can shed light on the exact pathophysiologic background of myocardial lesions, even if the underlying ARD seems stable. However, high cost and lack of availability and expertise limit wider adoption.Hopefully, CMR will not have the same fate as Oedipous, who despite answering the Sphinx’s riddle successfully, finally came to a bitter end; for in the case of CMR overcoming fate is, in fact, in our hands.

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Coronary microvascular dysfunction in chronic inflammatory rheumatoid diseases

Cited by 104 publications

References 109 publications

Microvascular dysfunction in ankylosing spondylitis is associated with disease activity and is improved by anti-TNF treatment

Microvascular dysfunction in ankylosing spondylitis is associated with disease activity and is improved by anti-TNF treatment

Update on cardiovascular disease in lupus

The Sphinx’s riddle: cardiovascular involvement in autoimmune rheumatic disease

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