Coronary microvascular dysfunction demonstrating improvement after surgery for inflammatory bowel disease
1. Inflammatory bowel disease (IBD) is associated with increased risk of coronary microvascular dysfunction (CMD).
2. Surgical intestinal resection in IBD patients improved coronary flow velocity reserve (CFVR), a measure of CMD.
Evidence Rating Level: 2 (Good)
Inflammatory bowel diseases (IBDs) include conditions such as Crohn Disease (CD) and Ulcerative Colitis (UC). They are characterized by acute and chronic inflammation of the gastrointestinal system, which can cause harm to the intestinal microvascular system and cardiovascular system. IBD was previously shown to be associated with reduced coronary flow velocity reserve (CFVR), a measure for coronary microvascular dysfunction (CMD). The current prospective study examined the extent of CMD in IBD patients, and the effect of surgical intestinal resection on coronary flow velocity (CFV) and CFVR. The study population consisted of 37 patients with IBD (aged 44±15), and 30 control patients (aged 46±12) with similar risk factors for coronary artery disease. The CFVR was measured with Doppler echocardiography, at rest and in hyperemia (during an infusion of ATP). For IBD patients, the CFVR was measured 1-5 days before and 3-6 months after surgical resection. The results found that 38% of IBD patients had CMD, whereas 0% of controls had CMD. At baseline, the CFVR was significantly less in IBD patients than in controls (for CD: 2.92±1.03, p < 0.05; and for UC: 2.99±0.65, p < 0.05). After surgery, coronary flow velocity was not significantly altered in IBD patients without CMD, whereas for those with CMD, the resting CFV was reduced (-19%±25%) and hyperemic CFV ameliorated (21%±34%). As well, CFVR was significantly improved in IBD patients both with and without CMD, though the extent of improvement was greater in those with CMD (interaction effect p < 0.001). The study showed that IBD is associated with greater risk of damage to the coronary arteries, and surgical resection may improve microvascular function.
Click to read the study in JAHA
Image: PD
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