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Abstract

Patients with anginal chest pain and normal coronary arteries (CP-NCA) may have reduced coronary blood flow reserve, abnormal endothelium-dependent vasodilator responses and higher levels of plasma endothelin-1. We recently showed that skin capillary density is lower in patients with CP-NCA. The aim of this study was to examine the relationship between capillary density (measured by intra-vital microscopy before and after maximisation with venous congestion) and flow-mediated dilatation (FMD) measured by brachial artery Doppler ultrasound and plasma endothelin levels. We studied 19 patients With CP-NCA [11 were hypertensive (age 60 ys, sitting BP on treatment 145/82mmHg) and 8 were normotensive (age 60 ys, BP 128/75mmHg)] and 9 healthy controls (age 59 ys, BP 125/78mmHg). Mean capillary density was significantly lower in patients with CP-NCA independent of their BP compared to healthy controls, both at baseline [55±5 in hypertensives, 61±3 in normotensive versus 73±4 in controls, p<0.001 ANOVA], and after maximisation [60±5, 67±3 versus 86±4 respectively, p<0.0001]. FMD was higher in controls than in normotensive CP-NCA who in turn had higher values than hypertensive CP-NCA (5.561 versus 4.329 versus 3.646%, p=0.056. Capillary density was markedly lower with higher plasma endothelin-1 levels in subjects with CP-NCA (r= - 0.7, p=0.01). In conclusion we confirmed a significant reduction in baseline and maximal skin capillary density in patients with CP-NCA independent of blood pressure. Our findings suggest that plasma endothelin-1 may be implicated in the pathogenesis of capillary rarefaction in this syndrome.

Capillaries, Endothelin, Microcirculation
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© American Journal of Hypertension, Ltd. 2001
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