Coronary flow reserve in patients with primary biliary cholangitis.
BACKGROUND
It is still not clear whether primary biliary cholangitis (PBC) is associated with abnormalities of the cardiovascular system. We aimed to assess the relationship between PBC and coronary flow reserve (CFR).


METHODS
Our inclusion criterion was a diagnosis of PBC with no clinical evidence of heart disease or metabolic syndrome. Coronary flow velocity in the left anterior descending coronary artery was measured using transthoracic Doppler echocardiography at rest (DFVr), and during adenosine infusion (DFVh). The corrected CFR (cCFR) was defined as the ratio of DFVh to DFVr corrected for cardiac workload (cDFVr). Microvascular resistance was also assessed in baseline (BMR) and hyperemic conditions (HMR).


RESULTS
37 PBC patients and 37 sex- and age-matched controls were considered. The cCFR was significantly lower in PBC patients (2.8 ± 0.7 vs. 3.7 ± 0.7, p < 0.0001), and abnormal (≤2.5) in 13 (35%) of them, but in none of the controls (p < 0.0001). The cDFVr was higher in patients with abnormal cCFR (29.0 ± 6.0 vs. 20.4 ± 4.5 cm/sec, p < 0.0001). The CFR and cCFR did not correlate with any characteristics of PBC, comorbidities or Framingham risk scores. The BMR and HMR correlated with time since PBC diagnosis and duration of symptoms.


CONCLUSION
The CFR is reduced in PBC, apparently due to mechanisms correlating with the time since diagnosis. In particular, the higher cDFVr with a lower basal resistance in patients with cCFR ≤ 2.5 suggests a compensatory mechanism against any cardiomyocyte bioenergetics impairment.
['Cazzagon|Nora|N|', 'Dal Lin|Carlo|C|', 'Famoso|Giulia|G|', 'Montisci|Roberta|R|', 'Franceschet|Irene|I|', 'Floreani|Annarosa|A|', 'Tona|Francesco|F|']
D000241:Adenosine D000368:Aged D001783:Blood Flow Velocity D016022:Case-Control Studies D002761:Cholangitis D003327:Coronary Disease D003331:Coronary Vessels D015150:Echocardiography, Doppler D005260:Female D053805:Fractional Flow Reserve, Myocardial D006801:Humans D016014:Linear Models D008297:Male D008875:Middle Aged D011446:Prospective Studies D018570:Risk Assessment D012307:Risk Factors D012720:Severity of Illness Index
Heart Microvascular resistance Cholestasis Coronary microvascular dysfunction