Clinical, laboratory and instrumental correlations with the functional significance of coronary artery stenosis in patients with stable coronary artery disease and hypertension

Background. A significant proportion of patients with coronary artery disease (CAD) require myocardial revascularization. Arterial hypertension (AH), as a major risk factor for CAD, may influence the extent and severity of coronary artery (CA) lesions. However, visual assessment of coronary stenosis based on angiographic imaging does not always reflect their true hemodynamic significance. Therefore, the use of invasive functional assessment methods, such as the instantaneous wave-free ratio (iFR), is recommended for quantifying the ischemic potential of borderline stenosis. At present, there are no established clinical predictors for identifying functionally significant coronary lesions. Developing predictive models based on clinical, laboratory, and non-invasive imaging parameters may enhance decision-making regarding myocardial revascularization and the management of modifiable risk factors.

Aim: To evaluate the associations between the functional significance of CA stenosis and clinical, laboratory, blood pressure (BP), and epicardial adipose tissue (EAT) parameters in patients with stable CAD and HT.

Material and Methods. The study included 82 patients (56 men; mean age 66.1 ± 8.5 years) with stable CAD and HT, all of whom had borderline (50–90%) CA stenosis identified by coronary angiography. All participants underwent comprehensive clinical and laboratory assessment, transthoracic echocardiography, 24-hour ambulatory BP monitoring (ABPM), computed tomography (CT) for EAT volume and density evaluation, and iFR measurement to determine the functional significance of coronary stenosis.

Results. Patients were divided into two groups based on iFR values: those with functionally significant stenosis (iFR ≤ 0.89; n = 58) and those without (iFR > 0.89; n = 24). Both groups were comparable in baseline clinical and laboratory parameters. Patients with functionally significant stenosis demonstrated significantly higher clinical systolic BP (SBP), 24-hour SBP, and pulse pressure; greater daytime SBP load; reduced heart rate variability; a higher percentage of blood monocytes; lower prevalence of abdominal obesity; and smaller left atrial (LA) size. Multivariate logistic regression analysis, confirmed by ROC analysis, identified clinical SBP, monocyte percentage, and LA size as independent predictors of functionally significant stenosis.

Conclusion. In patients with stable CAD and HT, the presence of functionally significant CA stenosis is associated with elevated SBP, increased monocyte count, and smaller LA size.

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