TY - ABST

T1 - Proteomics to identify biological pathways and develop prediction models of coronary microvascular dysfunction in women with angina and no obstructive coronary artery disease

AU - Prescott, E.

AU - Bove, K.

AU - Suhrs, H. E.

AU - Bechsgaard, D. F.

AU - Lange, T.

AU - Schroder, J.

AU - Nielsen, R. L.

AU - IPOWER Study Grp

PY - 2022

Y1 - 2022

N2 - AimsCoronary microvascular dysfunction (CMD) is a major cause of angina and impaired outcome. Protein biomarkers could simplify patient selection for assessment and help uncover pathophysiologic pathways.Methods and resultsWe quantified 184 protein biomarkers in 1471 women with angina and no obstructive coronary artery disease on angiography characterized for CMD by coronary flow velocity reserve (CFVR) by Doppler Echocardiography. Sixty-one biomarkers were significantly associated with CFVR (Figure 1). The strongest correlations were seen for renin, growth differentiation factor 15 (GDF15), brain natriuretic protein (BNP), NT-proBNP and adrenomedullin (ADM) (all p<1e-06). To identify pathophysiological patterns, we applied principal components (PC) analyses and weighted protein co-abundance network analyses. Two PCs with the highest loading on BNP/ NTproBNP and interleukin 6 (IL-6), respectively, were strongly associated with low CFVR. The weighted protein co-abundance network analyses identified two clusters associated with low CFVR reflecting involvement of hypertension/vascular function and immune modulation. For prediction of CMD (CFVR <2.25, n=646), data was split into model and validation cohorts. The best model using only clinical data had area under the receiver operating characteristic curve (ROC-AUC) of 0.61 (95% CI 0.56–0.66). ROC-AUC improved to 0.66 (95% CI: 0.62–0.71) with addition of biomarkers. Stringent two-layer cross-validated machine learning models had ROC-AUC ranging from 0.58 to 0.66 (Figure 2); the most predictive biomarkers were renin, BNP, NT-proBNP, GDF15 and ADM.ConclusionCMD was associated with biological pathways, particularly involving inflammation (IL-6), blood pressure (renin, ADM) and ventricular remodelling (BNP/NTproBNP). The identified biomarker pathways may prove potential treatment targets for CMD. Diagnostic models improved significantly when adding protein biomarkers to clinical information.

AB - AimsCoronary microvascular dysfunction (CMD) is a major cause of angina and impaired outcome. Protein biomarkers could simplify patient selection for assessment and help uncover pathophysiologic pathways.Methods and resultsWe quantified 184 protein biomarkers in 1471 women with angina and no obstructive coronary artery disease on angiography characterized for CMD by coronary flow velocity reserve (CFVR) by Doppler Echocardiography. Sixty-one biomarkers were significantly associated with CFVR (Figure 1). The strongest correlations were seen for renin, growth differentiation factor 15 (GDF15), brain natriuretic protein (BNP), NT-proBNP and adrenomedullin (ADM) (all p<1e-06). To identify pathophysiological patterns, we applied principal components (PC) analyses and weighted protein co-abundance network analyses. Two PCs with the highest loading on BNP/ NTproBNP and interleukin 6 (IL-6), respectively, were strongly associated with low CFVR. The weighted protein co-abundance network analyses identified two clusters associated with low CFVR reflecting involvement of hypertension/vascular function and immune modulation. For prediction of CMD (CFVR <2.25, n=646), data was split into model and validation cohorts. The best model using only clinical data had area under the receiver operating characteristic curve (ROC-AUC) of 0.61 (95% CI 0.56–0.66). ROC-AUC improved to 0.66 (95% CI: 0.62–0.71) with addition of biomarkers. Stringent two-layer cross-validated machine learning models had ROC-AUC ranging from 0.58 to 0.66 (Figure 2); the most predictive biomarkers were renin, BNP, NT-proBNP, GDF15 and ADM.ConclusionCMD was associated with biological pathways, particularly involving inflammation (IL-6), blood pressure (renin, ADM) and ventricular remodelling (BNP/NTproBNP). The identified biomarker pathways may prove potential treatment targets for CMD. Diagnostic models improved significantly when adding protein biomarkers to clinical information.

U2 - 10.1093/eurheartj/ehac544.1132

DO - 10.1093/eurheartj/ehac544.1132

M3 - Conference abstract in journal

VL - 43

SP - 1132

EP - 1132

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - Supplement 2

ER -