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Kitada R, Otsuka K, Fukuda D. Role of plaque imaging for identification of vulnerable patients beyond the stage of myocardial ischemia. Front Cardiovasc Med 2023; 10:1095806. [PMID: 37008333 PMCID: PMC10063905 DOI: 10.3389/fcvm.2023.1095806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/21/2023] [Indexed: 03/19/2023] Open
Abstract
Chronic coronary syndrome (CCS) is a progressive disease, which often first manifests as acute coronary syndrome (ACS). Imaging modalities are clinically useful in making decisions about the management of patients with CCS. Accumulating evidence has demonstrated that myocardial ischemia is a surrogate marker for CCS management; however, its ability to predict cardiovascular death or nonfatal myocardial infarction is limited. Herein, we present a review that highlights the latest knowledge available on coronary syndromes and discuss the role and limitations of imaging modalities in the diagnosis and management of patients with coronary artery disease. This review covers the essential aspects of the role of imaging in assessing myocardial ischemia and coronary plaque burden and composition. Furthermore, recent clinical trials on lipid-lowering and anti-inflammatory therapies have been discussed. Additionally, it provides a comprehensive overview of intracoronary and noninvasive cardiovascular imaging modalities and an understanding of ACS and CCS, with a focus on histopathology and pathophysiology.
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Knap M, Maciąg D, Trzeciak-Bereza E, Knap B, Czop M, Krupa S. Sleep Disturbances and Health Consequences Induced by the Specificity of Nurses' Work. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19169802. [PMID: 36011431 PMCID: PMC9408457 DOI: 10.3390/ijerph19169802] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Nursing staff working in a shift or night system are exposed to sleep disorders, which has a direct impact on the emergence of dangerous health consequences for them. Melatonin secretion is abnormal at night and the circadian rhythm is disturbed. The aim of the study was to assess the occurrence of sleep disorders and their consequences for the body in a group of representative nursing staff working in a shift and night system. PARTICIPANTS The study was conducted among 126 nurses who are generally healthy, employed in health care facilities in the Małopolskie voivodship. METHODS The Athens Insomnia Scale consisting of 8 test items was used to obtain research material: falling asleep, waking up at night, waking up in the morning, total sleep time, sleep quality, well-being the next day, mental and physical fitness the next day, and sleepiness during the next day. As well as an original questionnaire. RESULTS The research showed significant negative consequences of shift work on the health of health-care workers. The subjects noticed symptoms related to the nervous system, such as increased nervous tension 53%, lack of patience in 62% of all respondents. As many as 85% pointed to the negative impact of shift work on their family life, 82% of all respondents on social life and 56% of all respondents on sex life. The other variables were not confirmed. CONCLUSIONS Symptoms of insomnia are common among night-work nurses.
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Affiliation(s)
- Małgorzata Knap
- Institute of Health Sciences, Collegium Medicum of the Jan Kochanowski University, 25-369 Kielce, Poland
| | - Dorota Maciąg
- Faculty of Health Sciences, University of Business and Enterprise, 27-400 Ostrowiec Świętokrzyski, Poland
| | - Edyta Trzeciak-Bereza
- Faculty of Health Sciences, University of Business and Enterprise, 27-400 Ostrowiec Świętokrzyski, Poland
| | - Bartosz Knap
- Department of Experimental and Clinical Pharmacology, Faculty of Medicine, Doctoral School, Medical University of Lublin, 20-090 Lublin, Poland
| | - Marcin Czop
- Clinical Genetics Department, Medical University of Lublin, 20-080 Lublin, Poland
| | - Sabina Krupa
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, St. Warzywna 1A, 35-310 Rzeszow, Poland
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Oriyama S, Yamashita K. Effects of a snack on performance and errors during a simulated 16-h night shift: A randomized, crossover-controlled, pilot study. PLoS One 2021; 16:e0258569. [PMID: 34679125 PMCID: PMC8535457 DOI: 10.1371/journal.pone.0258569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Night shift workers might not eat due to their busy schedules during the night shift. However, food may not only satisfy hunger, but also affect performance and errors. The aim of this study was to clarify the effect of a snack on performance and errors during 2-day, 16-h, simulated night shifts. METHODS A randomized, repeated-measure, crossover study was performed to investigate subjective and cognitive performance in 15 healthy female adults (mean age, 21.7 years) after they consumed a snack (352 kcal) during a simulated night shift (16:00 to 09:00) from October to November 2018. The participants were kept awake from waking up in the morning to the next day at 09:00. Subjects were tested for performance on the Uchida-Kraepelin test, as well as for subjective feeling, body temperature, psychomotor vigilance test, and heart rate variability, before and after they consumed the snack. One day before the experiment, all participants wore an actigraphy monitoring device to determine their sleep state. RESULTS There was no difference between having (Snack condition) and not having (Skipping condition) the snack in sleep states the day before the experiment. On the day of the experiment, between 16:00 and 09:00, subjective sleepiness, fatigue, and body temperature were not different between the two conditions. Subjects maintained performance on the Uchida-Kraepelin test and showed a significant improvement in false starts on the psychomotor vigilance test, the primary outcome measure, in the Snack condition compared with the Skipping condition. The Snack condition was also associated with decreased high-frequency power, a decreased low-frequency power/high-frequency power ratio, and increased heart rate in the vagally mediated heart rate variability indices, which may reflect a higher ability to modulate cognitive and behavioral processes. CONCLUSIONS These results suggest that providing a snack to shift workers during night shifts might improve work safety and efficiency.
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Affiliation(s)
- Sanae Oriyama
- Division of Nursing Science Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kotomi Yamashita
- Doctoral Program in Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Xia L, Sun C, Zhu H, Zhai M, Zhang L, Jiang L, Hou P, Li J, Li K, Liu Z, Li B, Wang X, Yi W, Liang H, Jin Z, Yang J, Yi D, Liu J, Yu S, Duan W. Melatonin protects against thoracic aortic aneurysm and dissection through SIRT1-dependent regulation of oxidative stress and vascular smooth muscle cell loss. J Pineal Res 2020; 69:e12661. [PMID: 32329099 DOI: 10.1111/jpi.12661] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/07/2020] [Accepted: 04/14/2020] [Indexed: 12/12/2022]
Abstract
Melatonin functions as an endogenous protective molecule in multiple vascular diseases, whereas its effects on thoracic aortic aneurysm and dissection (TAAD) and underlying mechanisms have not been reported. In this study, TAAD mouse model was successfully induced by β-aminopropionitrile fumarate (BAPN). We found that melatonin treatment remarkably prevented the deterioration of TAAD, evidenced by decreased incidence, ameliorated aneurysmal dilation and vascular stiffness, improved aortic morphology, and inhibited elastin degradation, macrophage infiltration, and matrix metalloproteinase expression. Moreover, melatonin blunted oxidative stress damage and vascular smooth muscle cell (VSMC) loss. Notably, BAPN induced a decrease in SIRT1 expression and activity of mouse aorta, whereas melatonin treatment reversed it. Further mechanistic study demonstrated that blocking SIRT1 signaling partially inhibited these beneficial effects of melatonin on TAAD. Additionally, the melatonin receptor was involved in this phenomenon. Our study is the first to report that melatonin exerts therapeutic effects against TAAD by reducing oxidative stress and VSMC loss via activation of SIRT1 signaling in a receptor-dependent manner, thus suggesting a novel therapeutic strategy for TAAD.
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Affiliation(s)
- Lin Xia
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Chang Sun
- Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Hanzhao Zhu
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Mengen Zhai
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Liyun Zhang
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Liqing Jiang
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Peng Hou
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Junfeng Li
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Kaifeng Li
- Institute of Material Medical, School of Pharmacy, The Fourth Military Medical University, Xi'an, China
| | - Zhenhua Liu
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Buying Li
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Xiaowu Wang
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Wei Yi
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Hongliang Liang
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Zhenxiao Jin
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Jian Yang
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Dinghua Yi
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Jincheng Liu
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Shiqiang Yu
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Weixun Duan
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
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Nakao T, Yasumoto A, Tokuoka S, Kita Y, Kawahara T, Daimon M, Yatomi Y. The impact of night-shift work on platelet function in healthy medical staff. J Occup Health 2018; 60:324-332. [PMID: 29669967 PMCID: PMC6078842 DOI: 10.1539/joh.2018-0027-fs] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objectives: Rotating shift work has been reported to increase the risk of cardiovascular diseases. Vascular endothelial dysfunction and platelet activation are among the leading causes of thrombus formation in patients with myocardial infarction or stroke. Endothelial function has been shown to be impaired immediately after night-shift work; however, it is not known whether platelets are also activated. The aim of this study was to investigate the acute impact of night-shift work on platelet function. Methods: This observational study included 11 healthy medical staff members (seven women, median age 32 years). We examined each subject's platelet aggregation rates and the serum concentrations of eicosanoid mediators after night-shift work and on day-shift work without preceding night-shift work (baseline). Results: Platelet aggregation did not differ from baseline levels after night-shift work. However, serum cyclooxygenase (COX)-metabolized eicosanoid mediators, particularly thromboxane (Tx) B2 (a stable metabolite of TxA2 and the most important marker of platelet activation), were significantly higher after the night-shift than at baseline (median 65.3 vs 180.4 ng/ml). Conclusions: Although platelet aggregation did not increase, there was an increase in serum COX-metabolized eicosanoid mediators such as TxB2 in healthy medical staff after night-shift work. This platelet hypersensitivity may be one of the mechanisms underlying the significant association between night-shift work and adverse cardiovascular outcomes.
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Affiliation(s)
- Tomoko Nakao
- Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Atsushi Yasumoto
- Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Suzumi Tokuoka
- Department of Lipidomics, Graduate School of Medicine, The University of Tokyo
| | - Yoshihiro Kita
- Department of Lipidomics, Graduate School of Medicine, The University of Tokyo
| | - Takuya Kawahara
- Biostatistics Division, Clinical Research Support Center, The University of Tokyo Hospital
| | - Masao Daimon
- Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Yutaka Yatomi
- Department of Clinical Laboratory, The University of Tokyo Hospital
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Lee IT, Sheu WHH, Lee WJ, Chen DY. Serum brain-derived neurotrophic factor predicting reduction in pulse pressure after a one-hour rest in nurses working night shifts. Sci Rep 2018; 8:5485. [PMID: 29615787 PMCID: PMC5882896 DOI: 10.1038/s41598-018-23791-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 03/21/2018] [Indexed: 12/16/2022] Open
Abstract
Night shift work is associated with cardiovascular disease and central nervous system disorders in female nurses. Brain-derived neurotrophic factor (BDNF) exerts protective effects on neural and endothelial functions. This study examined the association between serum BDNF levels and pulse pressure after rest in female nurses working night shifts. In this study, blood samples were collected for BDNF measurement after a night shift when nurses had been working night shifts for three continuous weeks. Blood pressure was assessed before and after a one-hour morning rest within a week of resuming the night shift after one month without any night shift work. The pulse pressure of nurses (n = 48, age 29 ± 5 years) was significantly reduced (from 43 ± 7 to 41 ± 6 mmHg, P = 0.003) after rest, and serum BDNF were significantly and inversely correlated with pulse pressure changes (r = −0.435, P = 0.002). Higher serum BDNF was an independent factor for greater reduction in pulse pressure (95%CI = −0.609 ‒ −0.174, P = 0.001). Using a receiver operating characteristic curve analysis, serum BDNF >20.6 ng/mL predicted a pulse pressure reduction after a one-hour rest (sensitivity 66.7%, specificity 77.8%). In conclusion, higher serum BDNF predicted greater recovery of pulse pressure after a one-hour rest in female nurses after night shift work.
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Affiliation(s)
- I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Wen-Jane Lee
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Der-Yuan Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,PhD Program in Translational Medicine and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
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Associations of work hours, job strain, and occupation with endothelial function: the Multi-Ethnic Study of Atherosclerosis (MESA). J Occup Environ Med 2015; 56:1153-60. [PMID: 25376409 DOI: 10.1097/jom.0000000000000311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To investigate associations of work hours, job control, job demands, job strain, and occupational category with brachial artery flow-mediated dilation (FMD) in 1499 Multi-Ethnic Study of Atherosclerosis participants. METHODS Flow-mediated dilation was obtained using high-resolution ultrasound. Mean values of FMD were examined across categories of occupation, work hours, and the other exposures using regression analyses. RESULTS Occupational category was significantly associated with FMD overall, with blue-collar workers showing the lowest mean values-management/professional = 4.97 ± 0.22%; sales/office = 5.19 ± 0.28%; services = 4.73 ± 0.29%; and blue-collar workers = 4.01 ± 0.26% (adjusted P < 0.001). There was evidence of effect modification by sex (interaction P = 0.031)-significant associations were observed among women (adjusted P = 0.002) and nearly significant results among men (adjusted P = 0.087). Other exposures were not significantly associated with FMD. CONCLUSIONS Differences in endothelial function may account for some of the variation in cardiovascular disease across occupational groups.
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Harbeck B, Suefke S, Haas CS, Lehnert H, Kropp P, Moenig H. No stress after 24-hour on-call shifts? J Occup Health 2015; 57:438-47. [PMID: 26119209 DOI: 10.1539/joh.14-0276-oa] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Irregular sleep patterns can adversely affect physiological functions and have been associated with increased physiological and psychological stress. Nocturnal work of physicians during 24-hour on-call shifts (OCS) disrupts the sleep/wake cycle. Chronic exposure to distress has been shown to affect cardiovascular homeostasis and to impair performance in neurocognitive and simulated clinical tasks. METHODS In a prospective cohort study, biochemical and physiological stress parameters were assessed in 11 female and 9 male physicians (median age: 32 years, range 26-42 years) before a normal working day and after a 24-hour OCS in internal medicine. In addition, various tests of attentional performance (TAP) were conducted. RESULTS The levels of thyroid stimulating hormone (TSH) were significantly higher after a 24- hour OCS, while there were no significant changes in cortisol, epinephrine, and norepinephrine levels. Heart rate variability and skin resistance increased following an OCS, although the differences were not statistically significant. Intrinsic alertness was comparable, while phasic alertness was significantly improved following a 24-hour OCS. Focused attention tended to be better following a night shift. There was no correlation with age or medical working experience; however, men experienced more stress than women. CONCLUSIONS Following a 24-hour OCS, (i) TSH may be an early and sensitive biochemical predictor of stress; (ii) other classical biochemical stress parameters do not depict the psychological stress perceived by physicians; (iii) there may be a mismatch between experienced and objective stress levels; (iv) neurocognitive functions are not impaired, while performance may even be improved; and (v) men might be more sensitive to distress.
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Kono Y, Fukuda S, Hanatani A, Nakanishi K, Otsuka K, Taguchi H, Shimada K. Remote ischemic conditioning improves coronary microcirculation in healthy subjects and patients with heart failure. DRUG DESIGN DEVELOPMENT AND THERAPY 2014; 8:1175-81. [PMID: 25210440 PMCID: PMC4154883 DOI: 10.2147/dddt.s68715] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Remote ischemic conditioning (RIC) is a treatment modality that suppresses inflammation and improves endothelial function, which are factors involved in the pathogenesis of heart failure (HF) with reduced left ventricular ejection fraction. Coronary flow reserve (CFR) is a physiological index of coronary microcirculation and is noninvasively measured by transthoracic Doppler echocardiography (TTDE). This study aimed to investigate the effects of RIC on CFR in healthy subjects and patients with HF, through the assessment by TTDE. METHODS Ten patients with HF with left ventricular ejection fraction of less than 40%, and ten healthy volunteers were enrolled in this study. RIC treatment was performed twice a day for 1 week. Our custom-made RIC device was programmed to automatically conduct 4 cycles of 5 minutes inflation and 5 minutes deflation of a blood pressure cuff to create intermittent arm ischemia. CFR measurements and laboratory tests were examined before, and after 1 week of RIC treatment. RESULTS One week of RIC treatment was well tolerated in both groups. RIC treatment increased CFR from 4.0 ± 0.9 to 4.6 ± 1.3 (mean ± standard deviation) in healthy subjects (P=0.02), and from 1.9 ± 0.4 to 2.3 ± 0.7 in patients with HF (P = 0.03), respectively. Systolic blood pressure in healthy subjects, and heart rate in HF patients decreased after RIC treatment (both P<0.01). CONCLUSION This study demonstrated that a 1 week course of RIC treatment improved coronary microcirculation in healthy subjects and patients with HF associated with reduced left ventricular ejection fraction.
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Affiliation(s)
- Yasushi Kono
- Department of Medicine, Osaka Ekisaikai Hospital, Osaka, Japan
| | - Shota Fukuda
- Department of Medicine, Osaka Ekisaikai Hospital, Osaka, Japan
| | - Akihisa Hanatani
- Department of Internal Medicine and Cardiology, Osaka City University School of Medicine, Osaka, Japan
| | - Koki Nakanishi
- Department of Internal Medicine and Cardiology, Osaka City University School of Medicine, Osaka, Japan
| | - Kenichiro Otsuka
- Department of Internal Medicine and Cardiology, Osaka City University School of Medicine, Osaka, Japan
| | | | - Kenei Shimada
- Department of Internal Medicine and Cardiology, Osaka City University School of Medicine, Osaka, Japan
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Faraut B, Bayon V, Léger D. Neuroendocrine, immune and oxidative stress in shift workers. Sleep Med Rev 2013; 17:433-44. [DOI: 10.1016/j.smrv.2012.12.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 12/11/2012] [Accepted: 12/20/2012] [Indexed: 10/26/2022]
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Nakanishi K, Fukuda S, Shimada K, Miyazaki C, Otsuka K, Kawarabayashi T, Watanabe H, Yoshikawa J, Yoshiyama M. Prognostic value of coronary flow reserve on long-term cardiovascular outcomes in patients with chronic kidney disease. Am J Cardiol 2013; 112:928-32. [PMID: 23800551 DOI: 10.1016/j.amjcard.2013.05.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 05/08/2013] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
Abstract
Cardiovascular (CV) diseases and chronic kidney disease (CKD) have common predisposing factors that subsequently cause microvascular dysfunction. In the absence of obstructive coronary artery disease, coronary flow reserve (CFR) represents the status of coronary microcirculation. This study aimed to investigate the prognostic importance of impaired CFR, as a marker of microvascular dysfunction, on long-term CV outcomes in patients with CKD. This study consisted of 139 patients with an estimated glomerular filtration rate of <60 ml/min/1.73 m(2) who had no obstructive narrowing of the left anterior descending artery. Transthoracic Doppler echocardiography was used to measure CFR in the left anterior descending artery. During the follow-up period (3.3 ± 1.6 years), CV events occurred in 26 patients (18.7%). Multivariate analysis that included CFR as a continuous value identified a serum level of C-reactive protein (hazard ratio 1.41, p = 0.03) and a value of CFR (hazard ratio 0.21, p = 0.009) as determinants for CV events, independent of traditional CV risk factors. Patients with a CFR of <2.0 had worse CV outcomes compared with those with a CFR of ≥2.0 (p <0.001). In conclusion, transthoracic Doppler echocardiographically derived CFR was useful for the risk stratification of CV outcomes in patients with CKD. The presence of microvascular dysfunction may play an important role in the association between CKD and future CV events.
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