Background
Coronary endothelial dysfunction (CED) is regarded as an early stage of atherosclerosis. Inflammation plays a key role in the mechanism and progression of atherosclerosis, but its clinical utility in the initial phase is less clear.
Methods
Patients with angina and nonobstructive coronary artery disease who underwent coronary reactivity testing at the Mayo Clinic between 1997 and 2021 were enrolled. Endothelium-dependent microvascular dysfunction was a <50 % change in coronary blood flow, and endothelium-dependent epicardial dysfunction was a < −20 % change in epicardial arterial diameter, both with acetylcholine. Endothelium-independent microvascular dysfunction was a coronary flow reserve <2.5 with adenosine, and endothelium-independent epicardial dysfunction was a <20 % change in cross-sectional area after nitroglycerin. Preprocedural monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), and hs-CRP were used for major adverse cardiovascular and cerebrovascular events (MACCE) prediction.
Results
In 892 enrolled patients, with a median age of 52[43–61] years, 31 % were male. MLR was significantly higher in patients with endothelium-dependent epicardial (0.281 vs. 0.268, p = 0.042) and microvascular dysfunction (0.280 vs. 0.265, p = 0.015). However, no significant MLR differences were observed in patients with endothelium-independent epicardial or microvascular dysfunction.
In a 10-year follow-up, in univariate Cox Regression, higher MLR, NLR and hs-CRP levels were associated with higher MACCE. However, in multivariate Cox Regression for traditional risk factors, only MLR remained a significant independent predictor of MACCE (HR = 1.88, 95 %CI = 1.30–2.71, p < 0.001).
Conclusions
CED is associated with higher levels of MLR. Elevated MLR is independently linked to higher MACCE and may offer potential for early-stage atherosclerosis risk assessment.
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