title: Chronic Inflammatory Disease Is an Independent Risk Factor for Coronary Flow Velocity Reserve Impairment Unrelated to the Processes of Coronary Artery Calcium Deposition.
abstract: BACKGROUND
  Chronic inflammatory disease (CID) is a complex multisystem disease characterized by chronic inflammation, which can lead to coronary microvascular dysfunction (CMD) and can also predispose to coronary artery calcium deposition, even in the absence of obstructive coronary artery disease.
  
  
  METHODS
  Twenty-one patients with systemic lupus erythematosus (SLE; mean age, 60 ± 11 years), 21 patients with systemic sclerosis (SSc; mean age, 66 ± 11 years), 32 patients with rheumatoid arthritis (RA; mean age, 65 ± 9 years), and 23 control subjects with comparable traditional risk factors for coronary artery disease (mean age, 65 ± 10 years) were prospectively enrolled in the outpatient clinic. All study participants underwent transthoracic Doppler-derived echocardiography for coronary flow velocity reserve (CFVR) measurement in the left anterior descending coronary artery; CFVR < 2.5 defined CMD. Coronary artery calcium score in the left anterior descending coronary artery was also assessed by computed tomography.
  
  
  RESULTS
  None of study participants had obstructive coronary artery disease. The prevalence of CMD was 26% in the control group, 67% in the SLE group, 76% in the SSc group, and 63% in the RA group (P < .05, CID groups vs control group). CFVR was significantly lower in all three CID groups than in the control group (control group, 3.01 ± 0.72; SLE group, 2.23 ± 0.71; SSc group, 2.14 ± 0.54; RA group, 2.33 ± 0.62; P < .05, CID groups vs control group). In contrast, coronary artery calcium scores were similar in the four groups and had no relation to CMD. The odds ratios for CMD in patients with SLE, SSc, and RA were 16.70, 25.78, and 8.44 (P < .05) after adjusting for age, body mass index, the presence or absence of anemia, and hemoglobin level. Multiple linear regression analysis showed that only the presence of CID was independently associated with reduced CFVR among all study participants.
  
  
  CONCLUSIONS
  CID strongly contributes to CMD identified by qualitative evaluation of CFVR independently of traditional coronary risk factors of atherosclerosis but does not predispose to coronary artery calcification.
authors.affiliation: Department of Cardiology, Yokkaichi Hazu Medical Center, Yokkaichi, Japan; Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kakuta
authors.affiliation: Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan. Electronic address: dohik@clin.medic.mie-u.ac.jp.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Dohi
authors.affiliation: Department of Rheumatology and Clinical Immunology, Yokkaichi Hazu Medical Center, Yokkaichi, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Department of Cardiology, Yokkaichi Hazu Medical Center, Yokkaichi, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamanaka
authors.affiliation: Department of Cardiology, Yokkaichi Hazu Medical Center, Yokkaichi, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kawamura
authors.affiliation: Clinical Research Support Center, Mie University Hospital, Tsu, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Ogura
authors.affiliation: Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Nakamori
authors.affiliation: Department of Molecular and Laboratory Medicine, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Fujimoto
authors.affiliation: Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Eitaro
authors.initials: E
authors.lastname: Fujii
authors.affiliation: Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Norikazu
authors.initials: N
authors.lastname: Yamada
authors.affiliation: Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Ito
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications*; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology*; D002908:Chronic Disease; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology*; D003326:Coronary Circulation; D004452:Echocardiography / Q000379:methods*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000150:complications*; D014057:Tomography, X-Ray Computed
keywords: Chronic inflammatory disease; Coronary artery calcium score; Coronary flow velocity reserve; Coronary microvascular dysfunction