Key result
A decreased ratio of endothelial EVs (CD144+) to total EVs (< 0.00016) was an independent diagnostic predictor of INOCA compared to non-anginal chest pain (OR 3.38).
Why the study?
INOCA may be caused by coronary microvascular dysfunction, vasospastic angina, or both, prompting the evaluation of extracellular vesicles to differentiate these endotypes.
Does the concentration of extracellular vesicles differentiate between INOCA endotypes and non-anginal chest pain in patients with chronic coronary syndrome?
Cohort (n=96)
Yes
Does the concentration of extracellular vesicles differentiate between INOCA endotypes and non-anginal chest pain in patients with chronic coronary syndrome?
A decreased ratio of endothelial EVs (CD144+) to total EVs may serve as a novel circulating biomarker to identify patients with the mixed INOCA endotype (CMD + VSA).
Answers are grounded in this paper and cite their sources.
May support EV ratio as biomarker for mixed INOCA; hypothesis-generating and should not yet alter practice.
Ischemia and non-obstructive coronary artery disease (INOCA) might be due to coronary microvascular dysfunction (CMD), vasospastic angina (VSA) or both. We compared plasma concentration of various extracellular vesicles (EVs) in patients with different INOCA endotypes. Patients were divided into those with INOCA (CMD, VSA, mixed CMD + VSA) and non-anginal chest pain. Plasma concentrations of EVs were measured using flow cytometry. Out of 96 patients included, 34 had CMD (35%), 15 VSA (16%), 24 mixed endotype (25%) and 23 non-anginal chest pain (24%). Patients with INOCA had lower ratio of endothelial EVs (CD144 +) to total EVs, compared to patients with non-anginal pain ( p = 0.027). Patients with mixed endotype had lower ratio of endothelial EVs (CD144 +) to total EVs, compared to CMD ( p = 0.008), VSA ( p = 0.014) and non-anginal pain ( p < 0.001). Decreased ratio of endothelial EVs (CD144 +) to total EVs might serve as a "circulating footprint" of the mixed INOCA endotype. Graphical Abstract CCS – chronic coronary syndrome, CD – cluster of differentiation, CMD – coronary microvascular dysfunction, CFR – coronary flow reserve, EVs – extracellular vesicles, FFR – fractional flow reserve, INOCA - IMR – index of microvascular resistance, VSA – vasospastic angina
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Gąsecka et al. (2024) conducted a cohort in Ischemia and non-obstructive coronary artery disease (INOCA) (n=96). Ischemia and non-obstructive coronary artery disease (INOCA) vs. Non-anginal chest pain was evaluated on Difference in concentrations of extracellular vesicle (EV) subtypes (ratio of CD144+ endothelial EVs to total EVs) between patients with INOCA and non-anginal chest pain (OR 3.38, 95% CI 1.03-11.09, p=0.045). A decreased ratio of endothelial EVs (CD144+) to total EVs (< 0.00016) was an independent diagnostic predictor of INOCA compared to non-anginal chest pain (OR 3.38).
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