Association of impaired myocardial flow reserve with risk factors for cardiovascular diseases in patients with nonobstructive coronary artery disease

Aim. To reveal the association between disorders of myocardial blood flow and reserve, according to dynamic single photon emission computed tomography (SPECT), with risk factors for cardiovascular diseases (CVD) in patients with nonobstructive coronary artery disease (CAD).

Material and methods. The study included patients with suspected stable nonobstructive (<50%) CAD. Based on the survey data, anamnesis, out- and in-patient medical records, we analyzed main CVD risk factors. All patients underwent dynamic myocardial SPECT and analysis of blood lipid profile in vitro. Depending on myocardial flow reserve (MFR), two groups were formed: 1. With reduced MFR <2,0 (rMFR); 2. With normal MFR ≥2,0 (nMFR).

Results. The study included 47 patients divided into 2 following groups: the rMFR group consisted of 24 patients (15 men, age 56,3±9,1 years), the nMFR group — 23 patients (13 men, age 58,4±10,7 years). There was no significant difference in prevalence of CVD risk factors in groups. However, dyslipidemia was detected more often in rMFR patients (p=0,053): 58% vs 30%, respectively. In patients with rMFR, there were significantly higher levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C). Correlation analysis revealed significant negative inverse relationships between MFR values with TC (ρ=-0,36, p=0,01) and LDL-C (ρ=-0,38, p=0,009). According to univariate logistic regression, significant predictors of reduced MFR were TC (odds ratio (OR), 2,32; 95% confidence interval (CI), 1,17-4,59; p=0,01) and LDL-C (OR, 2,16; 95% CI, 1,04-4,51; p=0,04). According to a stepwise multivariate logistic regression analysis, only TC was an independent predictor of a decrease in MFR (OR, 2,32; 95% CI, 1,17-4,59; p=0,02).

Conclusion. MFR, determined by dynamic SPECT, is associated with TC and LDL-C levels. TC level is an independent predictor of a decrease in MFR.

1. Huang FY, Huang BT, Lv WY, et al. The Prognosis of Patients With Nonobstructive Coronary Artery Disease Versus Normal Arteries Determined by Invasive Coronary Angiography or Computed Tomography Coronary Angiography: A Systematic Review. Medicine (Baltimore). 2016;95(11):e3117. doi:10.1097/MD.0000000000003117.

2. Padro T, Manfrini O, Bugiardini R, et al. ESC Working Group on Coronary Pathophysiology and Microcirculation position paper on ‘coronary microvascular dysfunction in cardiovascular disease,. Cardiovasc Res. 2020;116(4):741-55. doi:10.1093/cvr/cvaa003.

3. Maltseva AN, Mochula AV, Kopyeva KV, et al. Radionuclide imaging methods in the diagnosis of microvascular dysfunction in non-obstructive coronary artery disease. Russian Journal of Cardiology. 2021;26(12):4746. (In Russ.) doi:10.15829/1560-4071-2021-4746.

4. Zavadovsky KV, Mochula AV, Maltseva AN, et al. The current status of CZT SPECT myocardial blood flow and reserve assessment: Tips and tricks. J Nucl Cardiol. 2022;29(6):3137-3151. doi:10.1007/s12350-021-02620-y.

5. Golukhova EZ, Shavman MG, Shurupova IV, et al. Characteristics of myocardial blood flow and coronary flow reserve by PET/CT in patients with coronary artery disease with different degrees of coronary artery stenosis. REJR. 2021;11(3):67-83. (In Russ.) doi:10.21569/2222-7415-2021-11-3-67-83.

6. Ferenczi P, Couffinhal T, Mamou A, et al. Myocardial blood flows and reserves on solid state camera: Correlations with coronary history and cardiovascular risk factors. J Nucl Cardiol. 2022;29(4):1671-1678. doi:10.1007/s12350-021-02659-x.

7. Mochula AV, Kop’eva KV, Maltseva AN, et al. Coronary flow reserve in patients with heart failure with preserved ejection fraction. Russian Journal of Cardiology. 2022;27(2):4743. (In Russ.) doi:10.15829/1560-4071-2022-4743.

8. Zavadovsky KV, Mochula AV, Maltseva AN, et al. The diagnostic value of SPECT CZT quantitative myocardial blood flow in high-risk patients. J. Nucl. Cardiol. 2022;29(3):1051-1063. doi:10.1007/s12350-020-02395-8.

9. Murthy VL, Naya M, Foster CR, et al. Improved cardiac risk assessment with noninvasive measures of coronary flow reserve. Circulation. 2011;124(20):2215-24. doi:10.1161/CIRCULATIONAHA.111.050427.

10. Ong P, Camici PG, Beltrame JF, et al. International standardization of diagnostic criteria for microvascular angina. Int J Cardiol. 2018;250:16-20. doi:10.1016/j.ijcard.2017.08.068.

11. Sergienko VB, Ansheles AA, Sergienko IV, et al. Relationship of obesity, low-density lipoprotein cholesterol and myocardial perfusion in patients with risk factors and without atherosclerotic cardiovascular diseases. Cardiovascular Therapy and Prevention. 2021;20(2):2734. (In Russ.) doi:10.15829/1728-8800-2021-2734.

12. Bairey Merz CN, Pepine CJ, Shimokawa H, et al. Treatment of coronary microvascular dysfunction. Cardiovasc Res. 2020;116(4):856-70. doi:10.1093/cvr/cvaa006.

13. Sampietro T, Sbrana F, Dal Pino B, et al. Coronary microcirculatory blood flow significantly increases upon acute and chronic cholesterol lowering: evaluation by cadmium-zinc-telluride cardiac imaging stress test. Eur J Prev Cardiol. 2022;29(8):e272-e274. doi:10.1093/eurjpc/zwac043.

14. Singh P, Emami H, Subramanian S, et al. Coronary Plaque Morphology and the Anti-Inflammatory Impact of Atorvastatin: A Multicenter 18F-Fluorodeoxyglucose Positron Emission Tomographic/Computed Tomographic Study. Circ Cardiovasc Imaging. 2016;9(12):e004195. doi:10.1161/CIRCIMAGING.115.004195.

15. Eshtehardi P, McDaniel MC, Dhawan SS, et al. Effect of intensive atorvastatin therapy on coronary atherosclerosis progression, composition, arterial remodeling, and microvascular function. J Invasive Cardiol. 2012;24(10):522-9.