Patients with coronary microvascular dysfunction had significantly lower nailfold capillary density (9.3±2.9 vs. 11±1.8 capillaries/mm, p=0.04) than controls.
Is coronary microvascular dysfunction associated with reduced peripheral nailfold capillary density in patients with ischemia and non-obstructive coronary arteries?
Patients with coronary microvascular dysfunction exhibit significantly lower nailfold capillary density, suggesting a systemic link between coronary and peripheral microvascular abnormalities.
Absolute Event Rate: 0% vs 0%
Abstract Background Recent studies indicate that patients with Ischemia with Non-Obstructive Coronary Arteries (INOCA) constitute a heterogeneous population at heightened risk of cardiovascular events. Nevertheless, there remains a paucity of scientific evidence investigating the potential presence of widespread microangiopathy in this distinct patient cohort. Purpose This study aims to evaluate nailfold capillary density in patients with INOCA compared to individuals without evidence of coronary microvascular dysfunction (CMD). Methods This single-center, prospective, observational study enrolled patients with INOCA. In the absence of significant coronary artery stenosis, functional coronary circulation was assessed in all patients. Coronary flow reserve (CFR) and the index of microvascular resistance (IMR) were invasively measured using the thermodilution technique with a temperature/pressure sensor-tipped guidewire in the left anterior descending coronary artery. Patients with CMD were further classified into two subgroups based on structural and functional endotypes, using CFR 2.5 and IMR ≥25 as tresholds to define abnormal values. Nailfold capillary circulation was evaluated in all participants using videocapillaroscopy, a non-invasive technique that assesses small vessels in the nailfold microcirculation, performed with a stereomicroscope. Results A total of 82 participants were enrolled in the study, including 36 controls without coronary microvascular dysfunction (non-CMD group) (16 female, 44%; mean age: 55.7 ± 7 years) and 46 patients with ischemia and non-obstructive coronary arteries (CMD group) (32 female, 69%; mean age: 51.9 ± 8.7 years). In the CMD group, the mean coronary flow reserve (CFR) and index of microvascular resistance (IMR) values were 1.68 ± 0.6 and 28 ± 23, respectively. Capillary density was significantly reduced in CMD patients compared to non-CMD participants (9.3 ± 2.9 vs. 11 ± 1.8 capillaries/mm, p = 0.04). This difference remained statistically significant after adjustment for multiple comparisons (p 0.05). No significant differences were observed between the CMD endotypes (functional vs. structural) regarding capillary circulation function (p = NS). Conclusions Patients with coronary microvascular dysfunction exhibit a significantly lower nailfold capillary density compared to individuals without CMD. These findings suggest a potential association between vascular abnormalities at both the coronary microcirculatory and peripheral vascular levels. The observed reduction in nailfold capillary density underscores its potential utility as a diagnostic marker for identifying coronary microvascular dysfunction in clinical practice. This parameter may be particularly valuable for risk stratification and guiding management strategies in the heterogeneous population of patients with INOCA.CMD correlation with capillary density CMD assessed by bolus thermodilution
Sakalidis et al. (Sat,) reported a other. Patients with coronary microvascular dysfunction had significantly lower nailfold capillary density (9.3±2.9 vs. 11±1.8 capillaries/mm, p=0.04) than controls.