Plasma Lipidomic Patterns in Patients with Symptomatic Coronary Microvascular Dysfunction

Abstract

Coronary microvascular dysfunction (MVD) is a syndrome of abnormal regulation of vascular tone, particularly during increased metabolic demand. While there are several risk factors for MVD, some of which are similar to those for coronary artery disease (CAD), the cause of MVD is not understood. We hypothesized that MVD in symptomatic non-elderly subjects would be characterized by specific lipidomic profiles. Subjects (n = 20) aged 35–60 years and referred for computed tomography coronary angiography (CTA) for chest pain but who lacked obstructive CAD (>50% stenosis), underwent quantitative regadenoson stress-rest myocardial contrast echocardiography (MCE) perfusion imaging for MVD assessment. The presence of MVD defined by kinetic analysis of MCE data was correlated with lipidomic profiles in plasma measured by liquid chromatography and high-resolution mass spectrometry. Nine of twenty subjects had evidence of MVD, defined by reduced hyperemic perfusion versus other subjects (beta-value 1.62 ± 0.44 vs. 2.63 ± 0.99 s−1, p = 0.009). Neither the presence of high-risk but non-obstructive CAD on CTA, nor CAD risk factors were different for those with versus without MVD. Lipidomic analysis revealed that patients with MVD had lower concentrations of long-carbon chain triacylglycerols and diacylglycerols, and higher concentrations of short-chain triacylglycerols. The diacylglycerol containing stearic and linoleic acid classified all participants correctly. We conclude that specific lipidomic plasma profiles occur in MVD involving saturated long-chain fatty acid-containing acylglycerols that are distinctly different from those in non-obstructive CAD. These patterns could be used to better characterize the pathobiology and potential treatments for this condition.

Emerging Pathway to a Precision Medicine Approach for Angina With Nonobstructive Coronary Arteries in Women

“… 46 , 47 Lower blood concentrations of long-chain fatty acid acylglycerols have been identified as a potential contributor to ANOCA, possibly through metabolic insufficiency for fatty acid oxidation and reduced metabolic efficiency. 48 Abnormal ratios of certain eicosanoid metabolites of arachidonic acid have also been associated with ANOCA, consistent with their role in regulating vascular tone. 49 Epicardial adipose tissue has been associated with ANOCA 50 and is also known to be a source of specific lipidomic features that are thought to act in a paracrine fashion to promote CAD and possibly abnormal vasoactive tone.…”

Landscape of lipidomics in cardiovascular medicine from 2012 to 2021: A systematic bibliometric analysis and literature review

“…We found that the application of lipidomics in CAD or atherosclerosis can be broadly divided into 2 categories by tracing the relevant primary literature. One of the 2 categories is to explore the lipid profiles of different disease subtypes, such as the characteristic lipid species of symptomatic coronary microangiopathy and acute myocardial infarction, [37][38][39] and the lipid profiles of plaques at different stages of atherosclerosis development. [40] The other is to explore the mechanisms of therapeutic effects based on lipidomic testing, such as proprotein convertase subtilisin/kexin type 9 inhibitors, [41,42] lifestyle interventions such as diet structure adjustment, limitation of smoking and alcohol consumption, and the intervention of effective active ingredients in Chinese herbs.…”

Cardiac allograft vasculopathy diagnosed by vasodilator myocardial contrast echocardiography perfusion imaging

“…From time‐intensity curves, a microvascular blood volume (A) value near 150 IU at rest and stress, and a microvascular flux rate (β) near 0.8 and 2.5 s −1 during rest and stress respectively were considered normal. 12 Microvascular blood flow was quantified by the product of microvascular blood volume and β. Flow reserve (β reserve) was calculated as the ratio of values obtained during regadenoson to those at rest.…”