title: Regional coronary endothelial function is closely related to local early coronary atherosclerosis in patients with mild coronary artery disease: pilot study.
abstract: BACKGROUND
  Coronary endothelial function is abnormal in patients with established coronary artery disease and was recently shown by MRI to relate to the severity of luminal stenosis. Recent advances in MRI now allow the noninvasive assessment of both anatomic and functional (endothelial function) changes that previously required invasive studies. We tested the hypothesis that abnormal coronary endothelial function is related to measures of early atherosclerosis such as increased coronary wall thickness.
  
  
  RESULTS
  Seventeen arteries in 14 healthy adults and 17 arteries in 14 patients with nonobstructive coronary artery disease were studied. To measure endothelial function, coronary MRI was performed before and during isometric handgrip exercise, an endothelial-dependent stressor, and changes in coronary cross-sectional area and flow were measured. Black blood imaging was performed to quantify coronary wall thickness and indices of arterial remodeling. The mean stress-induced change in cross-sectional area was significantly higher in healthy adults (13.5%±12.8%, mean±SD, n=17) than in those with mildly diseased arteries (-2.2%±6.8%, P<0.0001, n=17). Mean coronary wall thickness was lower in healthy subjects (0.9±0.2 mm) than in patients with coronary artery disease (1.4±0.3 mm, P<0.0001). In contrast to healthy subjects, stress-induced changes in cross-sectional area, a measure of coronary endothelial function, correlated inversely with coronary wall thickness in patients with coronary artery disease (r=-0.73, P=0.0008).
  
  
  CONCLUSIONS
  There is an inverse relationship between coronary endothelial function and local coronary wall thickness in patients with coronary artery disease but not in healthy adults. These findings demonstrate that local endothelial-dependent functional changes are related to the extent of early anatomic atherosclerosis in mildly diseased arteries. This combined MRI approach enables the anatomic and functional investigation of early coronary disease.
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA.
authors.forename: Allison G
authors.initials: AG
authors.lastname: Hays
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kelle
authors.forename: Glenn A
authors.initials: GA
authors.lastname: Hirsch
authors.forename: Sahar
authors.initials: S
authors.lastname: Soleimanifard
authors.forename: Jing
authors.initials: J
authors.lastname: Yu
authors.forename: Harsh K
authors.initials: HK
authors.lastname: Agarwal
authors.forename: Gary
authors.initials: G
authors.lastname: Gerstenblith
authors.forename: Michael
authors.initials: M
authors.lastname: Schär
authors.forename: Matthias
authors.initials: M
authors.lastname: Stuber
authors.forename: Robert G
authors.initials: RG
authors.lastname: Weiss
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012720:Severity of Illness Index; D055815:Young Adult