Doctors may face difficulties in accurately diagnosing whether chest pain or shortness of breath during exercise is due to coronary artery disease (CAD). Common symptoms of heart disease such as chest pain and shortness of breath can be ambiguous and may be caused by other medical conditions such as acid reflux or a pinched nerve. Often, individuals are not aware they have heart disease until they experience a potentially fatal heart attack. Currently, the standard method for diagnosing heart disease is through coronary angiography, which can be done through invasive catheterization or computed tomography. However, 20%-40% of angiograms result in a finding of no blockage. Therefore, doctors and patients may benefit from additional non-invasive and cost-effective diagnostic tools to accurately detect heart disease.

In the largest analysis of blood RNA from patients with angiographically confirmed coronary artery disease (CAD), researchers at the George Washington University (Washington, DC, USA) have demonstrated how RNA biomarkers could be utilized to confirm heart disease. The study has provided new insights into the understanding of heart disease and may potentially lead to the development of a simple blood test that doctors can use to diagnose heart disease right in their office.

The research team used cell type analysis of the differentially expressed genes and found they are related to decreasing abundance or differentiation state of T cells, especially T regulatory cells. The RNA changes are consistent with T cell-related changes in the immune synapse, which may help to define the precise cellular mechanisms of atherosclerotic lesion formation and suggest future optimal diagnostic and therapeutic targets. Combined with other evidence, the results suggest that CAD has an underappreciated component that is likely similar to other autoimmune diseases, such as lupus and psoriasis.

By conducting cell type analysis of the genes that were differentially expressed, the research team discovered a correlation between the decreased abundance or differentiation state of T cells, particularly T regulatory cells. The RNA changes were found to be consistent with T cell-related changes in the immune synapse, which could help to precisely define the cellular mechanisms that lead to the development of atherosclerotic lesions, and identify optimal diagnostic and therapeutic targets in the future. In conjunction with other evidence, these findings suggest that CAD shares a similar underappreciated component with other autoimmune diseases like lupus and psoriasis. 

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