Inflammation is Related to Coronary Flow Reserve Detected by Positron Emission Tomography in Asymptomatic Male Twins

• Published in: Journal of the American College of Cardiology Vol. 57; no. 11; pp. 1271 - 1279
• Main Authors: Vaccarino, Viola, Khan, Durreshahwar, Votaw, John, Faber, Tracy, Veledar, Emir, Jones, Dean P., Goldberg, Jack, Raggi, Paolo, Quyyumi, Arshed A., Bremner, J. Douglas
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.03.2011; Elsevier; Elsevier Limited
• Subjects: Ammonia; Arteritis - pathology; Arteritis - physiopathology; Biological and medical sciences; Biomarkers; Blood Flow Velocity - physiology; Blood pressure; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Cell adhesion & migration; circulation; Coronary Circulation - physiology; coronary disease; Coronary heart disease; Coronary Vessels - pathology; Coronary Vessels - physiopathology; Cross-Sectional Studies; Diabetes; endothelium; Family medical history; Heart; Heart rate; Humans; imaging; inflammation; Internal Medicine; Male; Medical sciences; Middle age; Middle Aged; Positron-Emission Tomography - methods; Registries; Risk factors; Twins; Twins, Dizygotic - physiology; Twins, Monozygotic - physiology; CRP; endothelium; IL; ICAM; CAD; imaging; CFR; MBF; coronary disease; VCAM; inflammation; circulation; WBC; PET; coronary artery disease; C-reactive protein; coronary flow reserve; myocardial blood flow; vascular cell adhesion molecule; interleukin; positron emission tomography; white blood cell count; intercellular adhesion molecule; Radionuclide study; Reserve; Coronary artery; Cardiovascular disease; Male; Asymptomatic; Inflammation; Coronary heart disease; Twin; Circulatory system; Cardiology; Positron emission tomography; Emission tomography
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2010.09.074

This study sought to examine the relationship between inflammation and coronary microvascular function in asymptomatic individuals using positron emission tomography (PET) and assessment of coronary flow reserve (CFR). Coronary microvascular dysfunction is an early precursor of coronary artery disease (CAD) thought to result from endothelial cell activation and inflammation, but data are limited. We examined 268 asymptomatic male monozygotic and dizygotic twins. Plasma biomarkers of inflammation and endothelial cell activation included C-reactive protein (CRP), interleukin (IL)-6, white blood cell count (WBC), vascular cell adhesion molecule (VCAM)-1, and intercellular adhesion molecule (ICAM)-1. Blood flow quantitation was obtained with [13N] ammonia PET at rest and after adenosine stress. CFR was measured as the ratio of maximum flow to baseline flow at rest; abnormal CFR was defined as a ratio <2.5. A summed stress score for visible perfusion defects was calculated. In within-pair analyses, all biomarkers, except VCAM-1, were higher in twins with lower CFR than their brothers with higher CFR (p < 0.05). This was observed in the entire sample, as well as within pairs discordant for a CFR of <2.5. Associations persisted after adjusting for summed stress score and CAD risk factors. In contrast no biomarker, except IL-6, was related to the summed stress score of visible defects. Even in asymptomatic subjects, a decrease in coronary microvascular function is accompanied by a systemic inflammatory response, independent of CAD risk factors. Our results, using a controlled twin design, highlight the importance of coronary microvascular function in the early phases of CAD.