@article {Parke001925, author = {Hyun Woong Park and Michel Corban and Takumi Toya and Ali Ahmad and Ilke Ozcan and Lilach Lerman and Amir Lerman}, title = {Impact of invasive aortic pulse pressure on coronary microvascular endothelial-independent dysfunction and on mortality in non-obstructive coronary artery disease}, volume = {9}, number = {1}, elocation-id = {e001925}, year = {2022}, doi = {10.1136/openhrt-2021-001925}, publisher = {Archives of Disease in childhood}, abstract = {Background Pulse pressure (PP), a raw index of arterial stiffness, is inversely related to coronary microvascular function, even among patients with non-obstructive coronary artery disease (CAD), as per non-invasive studies. We aimed to determine whether invasive aortic PP is associated with coronary microvascular endothelial dysfunction (CMED) and/or coronary microvascular endothelial independent dysfunction (CMEID) in patients with non-obstructed CAD.Methods We retrospectively analysed a cohort of 1894 patients (mean age, 51.2 years; 1261 (66.6\%) women) who presented with chest pain and non-obstructive CAD (angiographic stenosis \<50\%); coronary vasoreactivity was assessed in the mid-left anterior descending artery. The patients were classified based on whether aortic PP was high (>=50 mm Hg). CMEID was defined as abnormal coronary flow reserve (\<2.5) or hyperaemic myocardial resistance (\>2.0 mm Hg/cm/s), CMED was defined as abnormal acetylcholine-induced per cent change of coronary blood flow (<=50\%).Results Patients with high aortic PP had a higher rate of CMEID than those with low aortic PP (40.9 vs 25.2\%, p\<0.001). Conversely, aortic PP was not associated with CMED. On multivariate analysis, high aortic PP was associated with CMEID occurrence (OR 1.42, 95\% CI 1.13 to 1.78; p=0.003). On follow-up (median, 150 months), all-cause death was more frequent among patients with vs without high aortic PP (20.1\% vs 7.3\%, log-rank p\<0.001) and HR was 2.08 (95\% CI 1.34 to 3.32, p=0.002) on multivariate cox regression analysis. Furthermore, among patients with low aortic PP, CMEID was an independent risk factor for all-cause mortality (HR 2.04, 95\% CI 1.01 to 4.16, p=0.048).Conclusion In patients with non-obstructive CAD, invasive aortic PP was significantly associated with CMEID, but not with CMED. High aortic PP was an independent predictor of all-cause mortality, but CMEID was an independent risk factor in patients with low aortic PP.No additional data are available.}, URL = {https://openheart.bmj.com/content/9/1/e001925}, eprint = {https://openheart.bmj.com/content/9/1/e001925.full.pdf}, journal = {Open Heart} }