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. 2024 Jun 3;20(11):e690-e698.
doi: 10.4244/EIJ-D-23-00778.

Effects of age on microvascular function in patients with normal coronary arteries

Tijn P J Jansen  1 , Caïa Crooijmans  1 , Nico Pijls  2 , Valeria Paradies  2 , Annemiek de Vos  3 , Aukelien C Dimitriu-Leen  1 , Suzette Elias-Smale  1 , Laura Rodwell  4 , Niels van Royen  1 , Pieter Smits  2 , Peter Damman  1
Affiliations

Effects of age on microvascular function in patients with normal coronary arteries

Tijn P J Jansen et al. EuroIntervention. .

Abstract

Background: It has been suggested that coronary microvascular function decreases with age, irrespective of the presence of epicardial atherosclerosis.

Aims: Our aim is to quantitatively investigate the effects of age on microvascular function in patients with normal coronary arteries.

Methods: In 314 patients with angina with no obstructive coronary artery disease (ANOCA), microcirculatory function was tested using the continuous thermodilution method. In 305 patients, the association between age and both resting and hyperaemic myocardial blood flow (Q), microvascular resistance (Rμ), absolute coronary flow reserve (CFR) and microvascular resistance reserve (MRR) was assessed. In addition, patients were divided into 3 groups to test for differences based on age quartiles (≤52 years [24.9%], 53-64 years [49.2%], ≥65 years [25.9%]).

Results: The mean age was 59±9 years with a range from 22 to 79 years. The mean resting Q (Qrest) was not different in the 3 age groups (88±34 mL/min, 82±29 mL/min, and 86±38 mL/min, R2=0.001; p=0.62). A trend towards a decreasing mean hyperaemic Q (Qmax) was observed with increasing age (223±79 mL/min, 209±84 mL/min, 200±80 mL/min, R2=0.010; p=0.083). The mean resting Rμ (Rμ,rest) were 1,204±460 Wood units (WU), 1,260±411 WU, and 1,289±455 WU (p=0.23). The mean hyperaemic Rμ (Rμ,hyp) increased significantly with advancing age (429±149 WU, 464±164 WU, 503±162 WU, R2=0.026; p=0.005). Consequently, MRR decreased with age (3.2±1.2, 3.1±1.0, 2.9±0.9; p=0.038). This trend was present in both the patients with (n=121) and without (n=184) coronary microvascular dysfunction (CMD).

Conclusions: There is an age-dependent physiological increase in minimal microvascular resistance and decrease in microvascular function, which is represented by a decreased MRR and is independent of atherosclerosis. The age-dependent decrease in MRR was present in both patients with and without CMD and was most evident in patients with smooth coronary arteries.

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Conflict of interest statement

P. Damman has received consultancy fees and research grants from Philips; he has received a research grant from Abbott. N. Pijls has received institutional research grants from Abbott and Hexacath; is a consultant for Abbott and Opsens Medical; has minor equities in Philips, ASML, HeartFlow and General Electric; is a member of the scientific advisory board of HeartFlow; and has patents pending on diagnostic methods for quantifying aortic valve stenosis and microvascular physiology. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1. Mean absolute coronary flow (Q) at rest and during hyperaemia according to age group.
Resting absolute coronary flow (Qrest) remains the same with advancing age, but hyperaemic absolute coronary flow (Qmax) numerically reduces with ageing.
Figure 2
Figure 2. Prevalence of CMD according to age group.
The prevalence of CMD (based on an MRR cutoff of 2.7) in ANOCA patients numerically increases with advancing age. ANOCA: angina with no obstructive coronary artery disease; CMD: coronary microvascular dysfunction; MRR: microvascular resistance reserve; NS: not significant
Figure 3
Figure 3. Trends of Rµ,hyp and MRR in patients with and without CMD.
A) Patients with no CMD (normal coronaries) demonstrate a significant increase in Rµ,hyp, whereas patients with CMD only show a numerical increase. B) In the patients with no CMD, MRR demonstrates a decreasing trend with ageing. Patients with CMD demonstrate equal MRR values in the 3 age groups. CMD: coronary microvascular dysfunction; MRR: microvascular resistance reserve; NS: not significant; Rµ,hyp: hyperaemic absolute microvascular resistance; WU: Wood units
Central illustration
Central illustration. Effects of age on microvascular function in patients with normal coronary arteries.
A) The mean microvascular resistance during hyperaemia according to age group. Rµ,hyp increases as patients age, while Rµ,rest remains similar with advancing age. B) The mean MRR and CFR according to age group. The MRR decreases as patients with normal coronary arteries age, but the CFR does not significantly decrease in these patients. CFR: coronary flow reserve; MRR: microvascular resistance reserve; NS: not significant; Rµ,hyp: hyperaemic absolute microvascular resistance; Rµ,rest: resting absolute microvascular resistance; WU: Wood units
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