Coronary Microvascular Dysfunction (CMD), MACE, Microplastic Exposure, Nanoplastics
Conditions
Brief summary
With strict quality control procedures applied throughout microplastic testing, this study will assess the association between baseline circulating micro-nanoplastic exposure and coronary microvascular dysfunction, as well as subsequent long-term cardiovascular outcomes.
Detailed description
Using a prospective cohort study design, this study will enroll patients with clinical indications scheduled for invasive coronary angiography and coronary functional assessment. With a two-tiered framework of "pre-intervention baseline exposure assessment + procedural contamination quantification", it will be the first study to systematically evaluate the dose-response relationship between circulating microplastics and nanoplastics (MNPs) levels and coronary microvascular dysfunction (CMD). Through 2 years of follow-up, the effect of MNPs on the long-term prognosis of patients with CMD will also be assessed. Multi-modal omics technologies including pyrolysis-gas chromatography/mass spectrometry (Py-GC/MS), laser direct infrared spectroscopy (LDIR), and scanning electron microscopy coupled with energy dispersive X-ray spectroscopy (SEM-EDS) will be applied for the qualitative and quantitative detection of MNPs. The index of microcirculatory resistance (IMR) and coronary flow reserve (CFR), measured via the invasive thermodilution method recommended by the European Society of Cardiology (ESC), will be used to define and evaluate CMD. The core innovations of this protocol are twofold: The key blood samples for exposure measurement are strictly collected before any medical procedures are performed after admission, to maximally eliminate the confounding bias from iatrogenic interference in baseline MNPs exposure quantification. A three-level blank quality control system (procedural blank, environmental blank, device blank) is established to realize full-process monitoring and quantification of iatrogenic contamination. The entire study design strictly adheres to current technical recommendations and industry consensus in clinical practice, and demonstrates high feasibility, reproducibility, and reliability.
Interventions
OTHERmicro-nanoplastic examination
In this prospective cohort study, the investigators plan to perform a low-contamination protocol for the detection of circulating micro-nanoplastic particles in eligible subjects prior to the administration of invasive coronary angiography and concomitant coronary microvascular function assessment, so as to clarify the impact of micro-nanoplastic exposure status on coronary microvascular function and long-term prognosis.
PROCEDUREMicrovascular Function Examination
Using a catheter to perform invasive coronary functional assessment, including flow fraction reserve(FFR), coronary flow reserve (CFR) and index of microcirculation resistance (IMR)
Sponsors
Beijing Anzhen Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18; * Patients with clinical indications for undergoing invasive coronary angiography and coronary functional assessment (including fractional flow reserve \[FFR\], CFR, and IMR); * Voluntarily sign the written informed consent form.
Exclusion criteria
* The surgeon (or attending physician) determines that the patient is not suitable for or cannot tolerate a coronary physiological examination; * Intraoperative coronary angiography reveals a stenosis of\>90% in any non-left main coronary artery lumen or a stenosis of\>50% in the left main coronary artery lumen; * Left ventricular ejection fraction \<35% or cardiogenic shock or cardiac arrest; * Previous history of invasive procedures/treatments; * Active inflammatory diseases; * Connective tissue disease; * History of malignant tumors; * Expected lifespan \<2 years; * Pregnancy or lactation; * Subjects who refuse to comply with the pollution control measures set in this study; * Currently participating in other interventional clinical trials.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Baseline Peripheral Circulatory MNPs Concentration(μg/g, particles/ml) | baseline | Using multi-modal omics methodologies (Py-GC/MS, LDIR, and SEM-EDS), the investigators will evaluate the correlation between the total baseline peripheral circulatory concentration of MNPs and the baseline concentration of each specific particle type (reported as mass concentration in μg/g and particle count in particles/mL) in peripheral circulating blood and coronary sinus blood, and baseline coronary microvascular function |
| Coronary Microvascular Function | baseline | Using invasive functional examinations (Coronary Flow Reverse, CFR and Index of Microcirculatory Resistance, IMR) to evaluate coronary microvascular function. Coronary Microvascular Dysfunction (CMD) is diagnosed by CFR\<2.0 and IMR≥25. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 2 years Follow-up MACE | 2 years | Major Adverse Cardiovascular Events (MACE) is defined as a composition endpoint including all-cause death, non-fatal stroke, non-fatal myocardial infarction, hospitalization due to unstable angina, or heart failure events |
| Baseline Intracoronary MNPs Concentration(μg/g, particles/ml) | Baseline | Using multi-modal omics methodologies (Py-GC/MS, LDIR, and SEM-EDS), the investigators will evaluate the correlation between the total baseline intracoronary concentration of MNPs and the baseline concentration of each specific particle type (reported as mass concentration in μg/g and particle count in particles/mL) in both peripheral circulating blood and coronary sinus blood, and baseline coronary microvascular function. |
Outcome results
None listed