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Uygun H, Varan C, Konca C, Erdem N, Kazaz TG, Turgut M. Should aortic stiffness parameters be used in MIS-C patient follow-up? THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1525-1533. [PMID: 38748055 DOI: 10.1007/s10554-024-03133-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 05/04/2024] [Indexed: 07/19/2024]
Abstract
We evaluated the short- and long-term effects of multisystem inflammatory syndrome in children (MIS-C) on their cardiovascular system. The study population consisted of 38 MIS-C patients and 55 control patients. Standard echocardiographic measurements and aortic stiffness parameters were compared between the two groups at different time points. During the standard echocardiographic examination at the time of diagnosis, mitral valve insufficiency was detected in 42% of the cases, left ventricular systolic dysfunction in 36%, aortic valve insufficiency in 3%, tricuspid valve insufficiency in 13%, and coronary artery dilatation in 31%. The ejection fraction, pulse pressure of the experimental group were significantly lower than the control group (p < 0.01, p = 0.045, respectively). When aortic stiffness parameters were compared, it was seen that the parameters increased in the experimental group and the difference was significant for aortic distensibility. (p = 0.105, p = 0.029 respectively). When comparing the experimental group's results at diagnosis and at the sixth month, there was a decrease in aortic stiffness parameters at the sixth month compared to the time of diagnosis, but the difference wasn't significant (p = 0.514, p = 0.334). However, no statistically significant difference was detected when comparing the aortic distensibility results of the experimental group with the control group at the sixth month (p = 0.667). Our results showed that many pathological echocardiographic findings detected at diagnosis in MIS-C patients returned to normal within six months. Therefore, we believe that the cardiovascular follow-up period of MIS-C cases should be at least six months.
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Affiliation(s)
- Hatice Uygun
- Department of Pediatric Infectious Disease, Gaziantep University School of Medicine, University Boulevard, Sehitkamil-Gaziantep, 27310, Turkey.
| | - Celal Varan
- Department of Pediatric Cardiology, Adana City Hospital, Adana, Turkey
| | - Capan Konca
- Department of Pediatric Intensive Care, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Nurettin Erdem
- Department of Pediatric Infectious Disease, Sanlıurfa Training and Research Hospital, Sanlıurfa, Turkey
| | | | - Mehmet Turgut
- Department of Pediatric Infectious Disease, School of Medicine, Adiyaman University, Adiyaman, Turkey
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Kul S, Caklili OT, Tutuncu Y, Ozcan FB, Aksu F, Baycan OF, Atici A, Bilgili UZ, Takir M, Caliskan M. Endothelial dysfunction in patients with acromegaly and It's association with Endocan. Growth Horm IGF Res 2021; 56:101362. [PMID: 33221710 DOI: 10.1016/j.ghir.2020.101362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/15/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study aims to assess endocan levels in patients with acromegaly who have active disease or disease in remission and to investigate a relation between endocan levels and endothelial dysfunction in these patients. DESIGN The study is a case-control study. Study was conducted at Istanbul Medeniyet University Goztepe Training and Research Hospital between 2013 and 2019. Patients who were older than 18 years with acromegaly diagnosis were recruited if they agreed to participate. Patients with uncontrolled diabetes (DM), hypertension (HT), hyperlipidemia, decompensated heart failure, immune or infectious diseases, moderate-severe valve disease and stage 3 or more advanced chronic kidney disease were excluded. There were 30 healthy control subjects who agreed to participate to the study. Patients with acromegaly were divided into two groups as: disease active patients and patients in remission. Serum endocan levels were measured with enzyme linked immunosorbent assay (ELISA) method endothelial function was assessed with flow mediated dilatation (FMD). RESULTS There were 85 patients included to the study. Twenty-three patients had active disease, 31 were in remission and 31 were healthy controls. FMD was higher in controls compared to patients in active disease and patients in remission (p < 0.001). There was no difference between patients with active disease for FMD and patients in remission (p = 0.088). There was statistically significant correlation between FMD and endocan and insulin like growth hormone-1 (IGF-1) levels of patients with acromegaly. As FMD increased endocan and IGF-1 decreased. A moderate negative relation between FMD and endocan was identified (p < 0.001, r:-0.409) as well as FMD and IGF-1 levels (p:0.011, r:-0.377). Along with endocan and IGF-1, DM, HT, sex, body mass index, age and uric acid were associated with changes in FMD. CONCLUSIONS Endocan levels and endothelial function measured with FMD have an inverse relationship. Endocan may prove to be a marker for endothelial dysfunction in acromegaly.
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Affiliation(s)
- Seref Kul
- Istanbul Medeniyet University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Ozge Telci Caklili
- Istanbul University, Istanbul Faculty of Medicine, Department of Endocrinology, Istanbul, Turkey.
| | - Yasemin Tutuncu
- Endocrinology and Metabolism Clinic, Haydarpaşa Education and Training Hospital, Istanbul, Turkey
| | - Fatma Betul Ozcan
- Istanbul Medeniyet University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Feyza Aksu
- Istanbul Medeniyet University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Omer Faruk Baycan
- Istanbul Medeniyet University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Adem Atici
- Istanbul Medeniyet University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | | | - Mumtaz Takir
- Istanbul Medeniyet University Faculty of Medicine, Department of Endocrinology and Metabolism, Istanbul, Turkey
| | - Mustafa Caliskan
- Istanbul Medeniyet University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
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Razik NA, Kishk YT, Essa M, Ghany MA. Aortic Distensibility Can Predict Events in Patients With Premature Coronary Artery Disease: A Cardiac Magnetic Resonance Study. Angiology 2020; 72:332-338. [PMID: 33191760 DOI: 10.1177/0003319720968391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Noninvasive assessment of aortic distensibility (AD) is feasible with cardiac magnetic resonance (CMR). We investigated the relationship between AD (assessed by CMR) and coronary artery disease (CAD) severity (assessed by the SYNTAX score) in patients with premature CAD. We recruited 125 patients with CAD confirmed by coronary angiography (males were <55 years old and females <65 years old). We excluded patients with significant aortic disease or contraindications to CMR. We also recruited 25 age- and sex-matched healthy patients as controls. One-year follow-up was also carried out. Aortic distensibility at the aortic root (AR) and descending aorta (DA) was significantly (P < .001 for both) lower in the patient group. There was a significant negative correlation between SYNTAX score and AD at the AR (r = -0.56; P < .001) and DA (r = -0.34; P < .001), but insignificant correlation with distensibility at the ascending aorta (AA; r = -0.03; P = .81). AR, AA, and DA distensibility, as well as left ventricular ejection fraction were predictors of adverse events. The severity of CAD in young patients is associated with decreased AD, especially at the level of the AR. Aortic distensibility can predict adverse events in these patients.
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Affiliation(s)
- Nady A Razik
- Department of Cardiology, 68796Assiut University, Asyut, Egypt
| | - Y T Kishk
- Department of Cardiology, 68796Assiut University, Asyut, Egypt
| | - Mohammed Essa
- Department of Cardiology, 68796Assiut University, Asyut, Egypt
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Aortopathic effect of androgenic anabolic steroids. J Echocardiogr 2020; 19:113-117. [PMID: 33044714 DOI: 10.1007/s12574-020-00495-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/19/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Anabolic androgens have been reported to be associated with cardiovascular complications. One study revealed that increase in vascular stiffness in bodybuilders is associated with anabolic androgens and improvement in vascular function may occur following anabolic androgens discontinuation. The aim of this study was to investigate any possible relation between aortic elastic properties and anabolic androgens. METHODS Study population was divided into 3 groups: Group-1 [n = 35] consisted of bodybuilders who denied any current or previous use of anabolic androgens. Group-2 [n = 18] was bodybuilders with regular using of anabolic androgens for at least 2 year prior to the start of our study. Group-3 was 13 healthy age-matched sedentary men as a control group. Cardiac echocardiography was performed in the bodybuilders and controls and indexes of aortic function were calculated. RESULTS Aortic stiffness was approximately twofold higher in anabolic androgens user bodybuilders compared with drug-free bodybuilders [P < 0.001]. CONCLUSION The present study demonstrates that chronic anabolic androgens use clearly produces significant decrease in the elastic properties of aorta.
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Noori NM, Teimouri A, Keshavarz K, Moradi M. Assessment of Aortic Elasticity and the Doppler Tissue Echocardiography in Thalassemia Major Children. JOURNAL OF CHILD SCIENCE 2020. [DOI: 10.1055/s-0040-1713595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractCardiovascular diseases are the most common illness that needs special medical care in thalassemia particularly in children and adolescents. We aimed to compare aortic stiffness in thalassemia major and healthy children. The study included 65 asymptomatic thalassemia major 6 to 19-year–old children without known history of heart disease and 65 age- and sex-matched healthy controls. Arterial stiffness indices determined using two-dimensional (2D) and Doppler echocardiography. Data were analyzed by SPSS 20.0 with 0.05 as significant error. From the study, results showed that systolic (p = 0.009) and diastolic (p < 0.001) blood pressures were higher in controls. Left ventricular mass index (LVMI) was higher in patients (p < 0.001). Aortic stiffness index (p < 0.001), pulse pressure (p < 0.001), and pressure strain elastic modulus (p < 0.001) were higher in patients, while aortic strain (p < 0.002) and aortic distensibility (p < 0.001) were lower significantly. Aortic stiffness index was correlated with diastole aorta (p = 0.005), systole aorta (p < 0.001), and LVMI (p < 0.001). Strain was correlated with diastole aorta (p < 0.001). Pulse pressure was correlated with systolic blood pressure (p < 0.001), diastolic blood pressure (p = 0.002) significantly. Aortic distensibility was correlated with systolic blood pressure (p = 0.039) and diastole aorta (p < 0.001) significantly. The pressure strain elastic modulus was correlated only with diastole aorta (p = 0.029). Concluded, aortic stiffness index, pulse pressure, and pressure strain elastic modulus were higher in thalassemia children, while aortic strain and aortic distensibility were lower. This increase may result in reduction of mechanical efficiency of the heart. Therefore, assessment of aortic elastic properties as nontraditional cardiovascular risk factors may contribute to the identification of cardiovascular risks in children with thalassemia
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Affiliation(s)
- Noor Mohammad Noori
- Children and Adolescent Health Research Center, Resistant Tuberculosis Institute, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Alireza Teimouri
- Children and Adolescent Health Research Center, Resistant Tuberculosis Institute, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Malihe Moradi
- School of Medicine, University of Medical Science, Zahedan, Iran
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Muroya T, Kawano H, Koga S, Ikeda S, Yamamoto F, Maemura K. Aortic Stiffness Is Associated with Coronary Microvascular Dysfunction in Patients with Non-obstructive Coronary Artery Disease. Intern Med 2020; 59:2981-2987. [PMID: 33268696 PMCID: PMC7759696 DOI: 10.2169/internalmedicine.5401-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective Associations between aortic stiffness and cardiovascular disease events are mediated in part by pathways that include coronary microvascular dysfunction (CMD) and remodeling. However, the relationship between aortic stiffness and CMD remains unclear. The present study aimed to determine whether aortic stiffness causes CMD as evaluated by the hyperemic microvascular resistance index (hMVRI) in patients with non-obstructive coronary artery disease (CAD). Methods The intracoronary physiological variables in 209 coronary arteries were evaluated in 121 patients with non-obstructive CAD (fractional flow reserve >0.80) or reference vessels. The cardio-ankle vascular index (CAVI) as a measure of aortic stiffness and atherosclerotic risk factors were also measured. Results Univariate analyses showed that hMVRI correlated with age (β=0.24, p=0.007), eicosapentaenoic acid (EPA; β=-0.18, p=0.048), EPA/arachidonic acid (AA) (EPA/AA) ratio (β=-0.22, p=0.014) and CAVI (β=0.30, p=0.001). A multivariate regression analysis identified CAVI (β=0.25, p=0.007) and EPA/AA ratio (β=-0.26, SE=0.211, p=0.003) as independent determinants of hMVRI. Conclusion Aortic stiffness may cause CMD in patients with non-obstructive CAD via increased coronary microvascular resistance. Aortic stiffness is associated with CMD which is evaluated as hyperemic microvascular resistance in patients with non-obstructive CAD.
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Affiliation(s)
| | - Hiroaki Kawano
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Seiji Koga
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Satoshi Ikeda
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Fumi Yamamoto
- Department of Cardiology, Ureshino Medical Center, Japan
| | - Koji Maemura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Abstract
UNLABELLED Aim We aimed to study the dimensions, systolic and diastolic functions of the left ventricle; dimensions and elasticity of the aorta; and carotid intima-media thickness and flow-mediated dilatation of the brachial artery in mitral valve prolapse. METHODS The study group consisted of 43 patients (mean age=13.3±3.9) and 42 healthy children (mean age=12.9±3.4). Left ventricular end-diastolic, end-systolic, left atrial diameters, interventricular septum, and left ventricular posterior wall thickness were measured. Ejection and shortening fractions were calculated by M-mode. Measurements were adjusted to the body surface area. Mitral annulus, and systolic and diastolic diameters of the aortic annulus and aorta at each level were obtained; z-scores, aortic strain, distensibility, stiffness index were calculated. Carotid intima-media thickness and flow-mediated dilatation were studied. Patients were classified as classical/non-classical mitral valve prolapse and younger/older patients. RESULTS Left ventricular end-systolic, end-diastolic, and left atrial diameters (p=0.009, p=0.024, p=0.001) and aortic z-scores at annulus, sinus valsalva, and sinotubuler junction were larger (p=0.008, p=0.003, p=0.002, respectively) in the mitral valve prolapse group. Aortic strain and distensibility increased and stiffness decreased at the ascending aorta in the patient group (p=0.012, 0.020, p=0.019, respectively). Classical mitral valve prolapse had lower strain and distensibility and higher stiffness of the aorta at sinus valsalva level (p=0.010, 0.027, 0.004, respectively). Carotid intima-media thickness was thinner in the patient group, especially in the non-classical mitral valve prolapse group (p=0.037). Flow-mediated dilatation did not differ among the groups. CONCLUSION Mitral valve prolapse is a systemic disease of the connective tissue causing enlarged cardiac chambers and increased elasticity of the aorta. Decreased carotid intima-media thickness in this group may indicate low atherosclerosis risk.
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Flintholm Raft K, Frestad D, Michelsen MM, Suhrs HE, Rask AB, Nilsson M, Hermann TS, Prescott E. Peripheral Endothelial Function and Coronary Flow Velocity Reserve Are Not Associated in Women with Angina and No Obstructive Coronary Artery Disease: The iPOWER Study. J Vasc Res 2017; 54:309-319. [DOI: 10.1159/000479374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/05/2017] [Indexed: 01/22/2023] Open
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Lembo M, Sicari R, Esposito R, Rigo F, Cortigiani L, Lo Iudice F, Picano E, Trimarco B, Galderisi M. Association Between Elevated Pulse Pressure and High Resting Coronary Blood Flow Velocity in Patients With Angiographically Normal Epicardial Coronary Arteries. J Am Heart Assoc 2017; 6:e005710. [PMID: 28663250 PMCID: PMC5586295 DOI: 10.1161/jaha.117.005710] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/17/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim of our study was to evaluate the relationship of pulse pressure (PP), a raw index of arterial stiffness, with noninvasively determined coronary flow reserve (CFR) and its components, in patients with angiographically normal epicardial coronary arteries. METHODS AND RESULTS The study population included 398 patients without angiographic evidence of coronary stenosis, who underwent high-dose dipyridamole stress echocardiography with transthoracic-derived CFR evaluation on the left anterior descending artery. CFR was calculated as the ratio between high-dose dipyridamole and resting coronary diastolic peak velocities. Patients were divided into 2 groups: the first group included the first and second PP tertiles (n=298, PP ≤60 mm Hg) and the second group included the highest PP tertile (n=100, PP >60 mm Hg). Mean blood pressure, systolic blood pressure (both P<0.0001), age (P<0.002), and left ventricular mass index (P=0.013) were higher in the highest PP tertile, which also showed higher resting coronary flow velocity (31.6±9.6 cm/s versus 27.7±6.4 cm/s, P<0.0001) and marginally lower CFR (2.5±0.6 versus 2.6±0.6, P=0.044). Hyperemic coronary flow velocity did not differ between the 2 groups. By separate multiple linear regression analyses, after adjusting for sex, age, the highest systolic blood pressure tertile (≥140 mm Hg), left ventricular mass index, and cardiovascular risk factors, the highest PP tertile was associated with resting coronary flow velocity (P=0.003) and only marginally with hyperemic coronary flow velocity (P<0.02), whereas its association with CFR was not significant. CONCLUSIONS In patients without epicardial coronary artery stenosis, the highest PP tertile is associated with an increased coronary flow velocity at rest.
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Affiliation(s)
- Maria Lembo
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Rosa Sicari
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Fausto Rigo
- Department of Cardiology, Dell'Angelo Hospital, Mestre, Italy
| | | | - Francesco Lo Iudice
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Eugenio Picano
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
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Rai H, Sinha N. Genetic Determinants and Biochemical Correlates of Slow Coronary Flow: A Systematic Review and Meta-analysis. EXPLORATORY RESEARCH AND HYPOTHESIS IN MEDICINE 2017; 2:1-2. [DOI: 10.14218/erhm.2016.00010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Coronary flow reserve in patients with resistant hypertension. Clin Res Cardiol 2016; 106:151-157. [PMID: 27747373 DOI: 10.1007/s00392-016-1043-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
Resistant hypertension is associated with increased risk for cardiovascular events. Coronary flow reserve (CFR) is impaired in patients with hypertension and an independent predictor of cardiac mortality. However, there are no published data on CFR in the subset of treatment-resistant hypertension. The aim of this study was to assess CFR in patients with resistant hypertension. Twenty-five consecutive patients with primary resistant hypertension, scheduled for renal denervation, 25 matched patients with controlled hypertension, and 25 healthy controls underwent transthoracic colour Doppler echocardiography at rest and during adenosine infusion. Patients with hypertension were pair-matched with regard to age, sex, ischemic heart disease, diabetes mellitus, smoking status, and body-mass index. Healthy controls were selected according to age and sex. Mean flow velocity was measured in the left coronary anterior descending artery. Baseline mean flow velocities were similar in patients with controlled and resistant hypertension. CFR was significantly lower in patients with resistant hypertension as compared to individuals with non-resistant hypertension (2.7 ± 0.6 vs. 3.1 ± 0.8; p = 0.03). Systolic office blood pressure was significantly higher in patients with resistant hypertension (169 ± 20 vs. 144 ± 21 mm Hg; p < 0.01). Heart rate, ventricular mass, and ejection fraction were similar in the two groups. Healthy controls showed significantly lower baseline velocity, higher CFR, and lower blood pressure as compared to hypertensives. Resistant hypertension was associated with impaired CFR as compared to individuals with non-resistant hypertension indicating impaired cardiac microvascular function which may contribute to the increased risk of adverse outcome in patients with resistant hypertension.
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Caliskan Z, Keles N, Gokturk HS, Ozdil K, Aksu F, Ozturk O, Kahraman R, Kostek O, Tekin AS, Ozgur GT, Caliskan M. Is activation in inflammatory bowel diseases associated with further impairment of coronary microcirculation? Int J Cardiol 2016; 223:176-181. [PMID: 27541650 DOI: 10.1016/j.ijcard.2016.08.141] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 08/05/2016] [Accepted: 08/06/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Inflammatory bowel disease [IBD] includes a number of chronic relapsing diseases. In IBD intestinal microvascular endothelial cells are damaged by an abnormal immune response. Several studies have shown that IBD may cause increment in risk of developing atherosclerosis. IBD in activation was related to enhanced risks of worse cardiovascular [CV] outcome, on the other hand no risk increment was seen in remission comparing to control group in those studies. Coronary Flow Reserve [CFR] reflects coronary microvascular circulation. Coronary microvascular dysfunction may be defined as a predictor of CV outcome combined with previous described atherosclerotic risk factors. The present study was purposed to further evaluate whether or not CFR in the left anterior descending artery [LAD] is disturbed in IBD patients with activation in comparison to remission and healthy subjects. METHODS 62 patients with IBD and 39 healthy volunteers were enrolled into the study. Patients' demographics were recorded. CFR evaluation of patients with IBD in both activation and remission period and control group were performed with transthoracic echocardiography. RESULTS CFR was significantly lowest in the active period of the IBD [2.26 [2.08-2.55] vs. 2.55 [2.18-3.00] and 3.10 [2.85-3.29] p<0.001]. CFR is negatively correlated with disease activity scores of IBD. CONCLUSION This study showed that CFR is more prominently disturbed in patients with IBD in activation. The activation of disease may have a major role in the progression of coronary microcirculatory dysfunction and future cardiovascular events.
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Affiliation(s)
- Zuhal Caliskan
- Baskent University Department of Gastroenterology, Konya, Turkey
| | - Nursen Keles
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
| | | | - Kamil Ozdil
- Umraniye Training and Research Hospital Department of Gastroenterology, Istanbul,Turkey
| | - Feyza Aksu
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Oguzhan Ozturk
- Umraniye Training and Research Hospital Department of Gastroenterology, Istanbul,Turkey
| | - Resul Kahraman
- Umraniye Training and Research Hospital Department of Gastroenterology, Istanbul,Turkey
| | - Osman Kostek
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Internal Medicine, Istanbul, Turkey
| | - Ahmet S Tekin
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | | | - Mustafa Caliskan
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
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Akdag S, Akyol A, Cakmak HA, Gunbatar H, Asker M, Babat N, Tosu AR, Yaman M, Gumrukcuoglu HA. A Novel Echocardiographic Method for Assessing Arterial Stiffness in Obstructive Sleep Apnea Syndrome. Korean Circ J 2015; 45:500-9. [PMID: 26617653 PMCID: PMC4661366 DOI: 10.4070/kcj.2015.45.6.500] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 03/31/2015] [Accepted: 06/02/2015] [Indexed: 11/20/2022] Open
Abstract
Background and Objectives Obstructive sleep apnea syndrome (OSAS) is associated with increased arterial stiffness and cardiovascular complications. The objective of this study was to assess whether the color M-mode-derived propagation velocity of the descending thoracic aorta (aortic velocity propagation, AVP) was an echocardiographic marker for arterial stiffness in OSAS. Subjects and Methods The study population included 116 patients with OSAS and 90 age and gender-matched control subjects. The patients with OSAS were categorized according to their apnea hypopnea index (AHI) as follows: mild to moderate degree (AHI 5-30) and severe degree (AHI≥30). Aortofemoral pulse wave velocity (PWV), carotid intima-media thickness (CIMT), brachial artery flow-mediated dilatation (FMD), and AVP were measured to assess arterial stiffness. Results AVP and FMD were significantly decreased in patients with OSAS compared to controls (p<0.001). PWV and CIMT were increased in the OSAS group compared to controls (p<0.001). Moreover, AVP and FMD were significantly decreased in the severe OSAS group compared to the mild to moderate OSAS group (p<0.001). PWV and CIMT were significantly increased in the severe group compared to the mild to moderate group (p<0.001). AVP was significantly positively correlated with FMD (r=0.564, p<0.001). However, it was found to be significantly inversely related to PWV (r=-0.580, p<0.001) and CIMT (r=-0.251, p<0.001). Conclusion The measurement of AVP is a novel and practical echocardiographic method, which may be used to identify arterial stiffness in OSAS.
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Affiliation(s)
- Serkan Akdag
- Department of Cardiology, Yuzuncu Yil University Medical Faculty, Van, Turkey
| | - Aytac Akyol
- Department of Cardiology, Yuzuncu Yil University Medical Faculty, Van, Turkey
| | | | - Hulya Gunbatar
- Department of Pulmonary Diseas, Yuzuncu Yil University Medical Faculty, Van, Turkey
| | - Muntecep Asker
- Department of Cardiology, Yuzuncu Yil University Medical Faculty, Van, Turkey
| | - Naci Babat
- Department of Cardiology, Yuzuncu Yil University Medical Faculty, Van, Turkey
| | - Aydin Rodi Tosu
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Training Hospital, Istanbul, Turkey
| | - Mehmet Yaman
- Department of Cardiology, Samsun Education and Training Hospital, Samsun, Turkey
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Çörtük M, Akyol S, Baykan AO, Kiraz K, Uçar H, Çaylı M, Kandiş H. Aortic stiffness increases in proportion to the severity of apnoea-hypopnea index in patients with obstructive sleep apnoea syndrome. CLINICAL RESPIRATORY JOURNAL 2014; 10:455-61. [PMID: 25401950 DOI: 10.1111/crj.12244] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 10/13/2014] [Accepted: 11/10/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Obstructive sleep apnoea syndrome (OSA) and aortic stiffness are associated with an increased risk of cardiovascular morbidity and mortality. Although aortic stiffness increased in patients with OSA, the relationship between severity of OSA indicated with apnoea-hypopnea index (AHI) and aortic stiffness was not investigated in previous studies. The aim of this study is to investigate the relationship between the severity of OSA and aortic stiffness. METHODS In the present study, 90 consecutive OSA patients definite diagnosed with sleep test were prospectively included (mean age 54.5 ± 11.6 years). Aortic pulse wave velocity (PWV) and augmentation index (AIx) were calculated using the single-point method via the Mobil-O-Graph® ARCsolver algorithm. Aortic distensibility (AD) was calculated from the echocardiographically derived ascending aorta diameters and haemodynamic pressure measurements. Overnight full-laboratory polysomnography examination was conducted on each subject. Patients were classified into two groups according to their median AHI values (AHIlow and AHIhigh groups). RESULTS PWV values were higher and AD values were lower in AHIhigh group compared with AHIlow group (P < 0.05, for all). AHI was associated with body mass index (BMI), systolic blood pressure, pulse pressure, aortic diameter, AD, AIx and PWV in bivariate analysis (P < 0.05, for all). Multivariate linear regression analysis showed that AHI was independently associated with BMI (β = 0.175, P = 0.047), PWV (β = 0.521, P < 0.001) and aortic distensibility (β = -0.223, P = 0.020). CONCLUSIONS Aortic stiffness is associated both with the presence and the severity of OSA.
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Affiliation(s)
- Mustafa Çörtük
- Department of Pulmonology Medicine, Karabük University Medical Faculty, Karabük, Turkey
| | - Selahattin Akyol
- Department of Cardiology, Adana Training and Research Hospital, Adana, Turkey
| | - Ahmet O Baykan
- Department of Cardiology, Adana Training and Research Hospital, Adana, Turkey
| | - Kemal Kiraz
- Department of Pulmonology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Hakan Uçar
- Department of Cardiology, Adana Training and Research Hospital, Adana, Turkey
| | - Murat Çaylı
- Department of Cardiology, Adana Training and Research Hospital, Adana, Turkey
| | - Hayati Kandiş
- Department of Emergency Medicine, Düzce University Medical Faculty, Düzce, Turkey
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15
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Naya M, Tamaki N, Tsutsui H. Coronary flow reserve estimated by positron emission tomography to diagnose significant coronary artery disease and predict cardiac events. Circ J 2014; 79:15-23. [PMID: 25744627 DOI: 10.1253/circj.cj-14-1060] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Coronary artery disease (CAD) is a major cause of death in Japan. Coronary angiography is useful to assess the atherosclerotic burden in CAD patients, but its ability to predict whether patients will respond favorably to optimal medical therapy and revascularization is limited. The measurement of the fractional flow reserve with angiography is a well-validated method for identifying ischemic vessels. However, neither an anatomical assessment nor a functional assessment can delineate microvasculature or estimate its function. The quantitative coronary flow reserve (CFR) estimated from sequential myocardial perfusion images obtained by positron emission tomography (PET) during stress provides an accurate index of hyperemic reactivity to vasodilatory agents in the myocardium. In fact, there is growing evidence that the CFR reflects disease activity in the entire coronary circulation, including epicardial coronary artery stenosis, diffuse atherosclerosis, and microvascular dilatory function. Importantly, reduced CFR is observed even in patients without flow-limiting coronary stenosis, and its evaluation can improve the risk stratification of patients at any stage of CAD. This review focuses on the application of CFR estimated by cardiac PET for the diagnosis and risk stratification of patients with CAD.
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Affiliation(s)
- Masanao Naya
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
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16
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Gunbatar H, Sertogullarindan B, Ekin S, Akdag S, Arisoy A, Sayhan H. The correlation between red blood cell distribution width levels with the severity of obstructive sleep apnea and carotid intima media thickness. Med Sci Monit 2014; 20:2199-204. [PMID: 25380170 PMCID: PMC4301218 DOI: 10.12659/msm.891001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Obstructive sleep apnea syndrome (OSAS) is characterized by repetitive collapse of the upper airway during sleep. Red blood cell distribution width (RDW) increases platelet activation and has been reported as an independent predictor of adverse outcomes in the general population and is believed to be associated with cardiovascular morbidity and mortality. We evaluated RDW, mean platelet volume (MPV), and platelet distribution width (PDW) as a severity index in OSAS and the relationship between carotid intima media thickness and pulmonary hypertension. Material/Methods The study population consisted of 99 patients who were admitted to the sleep laboratory. Based on the apnea-hypopnea index, patients were grouped into 3 OSAS severity categories. Morning blood samples were withdrawn from patients after a 12-hour fasting period. MPV, PDW, and RDW were measured in a blood sample. Bilateral common carotid arteries of the patients were scanned. Results Ninety-nine patients – 73 with OSAS and 26 simple snoring control cases – were included. Mean values of MPV, PDW, and RDW were similar in patients compared to simple snoring subjects in the control group (p=0.162, p=0.656, p=0.091). RDW showed an inverse correlation with mean desaturation and lowest desaturation (p<0.01). Body mass index, apnea-hypopnea index, pulmonary artery pressure, and desaturation time under 90% were positively correlated with RDW (p<0.05). MPV, PDW, and carotid intima media thickness had no correlation with any other parameters. Conclusions The study showed a positive relationship between RDW and the apnea-hypopnea index and systolic pulmonary hypertension in patients with OSAS.
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Affiliation(s)
- Hulya Gunbatar
- Department of Pulmonary and Critical Care, Yuzuncu Yil University, Medical Faculty, Van, Turkey
| | | | - Selami Ekin
- Department of Pulmonary and Critical Care, Yuzuncu Yil University, Medical Faculty, Van, Turkey
| | - Serkan Akdag
- Department of Cardiology, Yuzuncu Yil University, Medical Faculty, Van, Turkey
| | - Ahmet Arisoy
- Department of Pulmonary and Critical Care, Special Istanbul Hospital, Van, Turkey
| | - Havva Sayhan
- Department of Anesthesiology, Special Lokman Hekim Hospital, Van, Turkey
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17
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Ciftci FC, Caliskan M, Ciftci O, Gullu H, Uckuyu A, Toprak E, Yanik F. Impaired coronary microvascular function and increased intima-media thickness in preeclampsia. ACTA ACUST UNITED AC 2014; 8:820-6. [PMID: 25455007 DOI: 10.1016/j.jash.2014.08.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 07/26/2014] [Accepted: 08/18/2014] [Indexed: 11/19/2022]
Abstract
There is an association between preeclampsia (PE) and excessive morbidity and mortality. Some recent studies have revealed the presence of endothelial dysfunction in PE patients with inflammatory activity. Moreover, it has been argued that the chronic inflammatory state involved in PE leads to an acceleration in atherosclerosis. Accordingly, our goal in this study is to determine whether there is any coronary microvascular dysfunction and increase in the intima-media thickness in patients who had mild PE 5 years before, without the presence of any traditional cardiovascular risk factors. The study included 33 mild PE patients (mild preeclampsia is classified as a blood pressure (BP) of 140/90 mm Hg or higher with proteinuria of 0.3 to 3 g/d) whose mean age was 33.7 years old, and 29 healthy women volunteers whose mean age was 36.1 years old. Each subject was examined using transthoracic echocardiography 5 years after their deliveries. During the echocardiographic examination, coronary flow reserve (CFR) and carotid intima-media thickness (IMT) were measured. There was a statistically lower CFR value in PE patients as compared with controls (2.39 ± 0.48 vs. 2.90 ± 0.49; P < .001). On the other hand, there was a significant increase in their IMT and high-sensitivity C-reactive protein (hs-CRP) values (respectively, 0.59 ± 0.15 vs. 0.46 ± 0.10; P < .001 and 3.80 ± 2.10 vs. 2.33 ± 1.79; P = .004). There was a negative correlation between the CFR values of the PE patients and hs-CRP (r = -0.568; P = .001) and IMT (r = -0.683, P < .001) results.We determined in the study that there was impaired CFR and increased carotid IMT in patients with PE, and, moreover, that these adverse effects were significantly correlated with hs-CRP.
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Affiliation(s)
- Faika C Ciftci
- Department of Obstetrics and Gynocology, Baskent University, Ankara, Turkey.
| | | | - Ozgur Ciftci
- Department of Cardiology, Baskent University, Ankara, Turkey
| | - Hakan Gullu
- Department of Cardiology, Baskent University, Ankara, Turkey
| | - Ayla Uckuyu
- Department of Obstetrics and Gynocology, Baskent University, Ankara, Turkey
| | - Erzat Toprak
- Department of Obstetrics and Gynocology, Baskent University, Ankara, Turkey
| | - Filiz Yanik
- Department of Obstetrics and Gynocology, Baskent University, Ankara, Turkey
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18
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Association between serum total antioxidant status and coronary microvascular function in idiopathic dilated cardiomyopathy. Herz 2014; 40:487-94. [DOI: 10.1007/s00059-013-4021-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 10/30/2013] [Accepted: 11/02/2013] [Indexed: 10/25/2022]
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19
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Gazi E, Temiz A, Altun B, Barutcu A, Silan F, Colkesen Y, Ozdemir O. Endothelial function and germ-line ACE I/D, eNOS and PAI-1 gene profiles in patients with coronary slow flow in the Canakkale population: multiple thrombophilic gene profiles in coronary slow flow. Cardiovasc J Afr 2014; 25:9-14. [PMID: 24435163 PMCID: PMC3959185 DOI: 10.5830/cvja-2013-083] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Accepted: 08/14/2013] [Indexed: 11/25/2022] Open
Abstract
Background We examined the effects of ACE, PAI-1 and eNOS gene polymorphisms on endothelial function. The genes are related to atherosclerosis and endothelial dysfunction in coronary slow flow (CSF). Methods Thirty-three patients with angiographically proven CSF and 48 subjects with normal coronary flow were enrolled in this study. Coronary flow patterns were determined by the thrombolysis in myocardial infarction (TIMI) frame count method. Endothelial function was assessed in the brachial artery by endothelium-dependent flow-mediated dilatation (FMD). PAI-1 4G/5G, eNOS T-786C and ACE I/D polymorphisms were determined by polymerase chain reaction (PCR) amplification. Results No difference was found between the groups regarding age, heart rate and blood pressure. Males were more prevalent among patients with CSF than control subjects (58.8 vs 29.8%, p = 0.009). Mean TIMI frame counts were significantly higher in CSF patients (24.2 ± 4.0 vs 13.1 ± 2.5 fpm, p = 0.001). FMD was significantly lower in CSF patients than in the controls (4.9 ± 6.6 vs 7.9 ± 5.6%, p = 0.029). TIMI frame count and FMD were found to be negatively correlated in a correlation analysis (r = –0.269, p = 0.015). PAI-1 4G/5G, eNOS T-786C and ACE I/D polymorphisms were similar in the two groups. Conclusions This study showed that endothelial function was impaired in patients with CSF. PAI-1, ACE and eNOS polymorphisms were not related to CSF in our study population.
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Affiliation(s)
- Emine Gazi
- Department of Cardiology, Faculty of Medicine, Canakkale Onsekiz mart University, Canakkale, Turkey
| | - Ahmet Temiz
- Department of Cardiology, Faculty of Medicine, Canakkale Onsekiz mart University, Canakkale, Turkey
| | - Burak Altun
- Department of Cardiology, Faculty of Medicine, Canakkale Onsekiz mart University, Canakkale, Turkey
| | - Ahmet Barutcu
- Department of Cardiology, Faculty of Medicine, Canakkale Onsekiz mart University, Canakkale, Turkey
| | - Fatma Silan
- Department of Medical Genetics, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Yucel Colkesen
- Department of Cardiology, Faculty of Medicine, Canakkale Onsekiz mart University, Canakkale, Turkey
| | - Ozturk Ozdemir
- Department of Medical Genetics, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
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20
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Otsuka T, Munakata R, Kato K, Kodani E, Ibuki C, Kusama Y, Seino Y, Kawada T. Oscillometric measurement of brachial artery cross-sectional area and its relationship with cardiovascular risk factors and arterial stiffness in a middle-aged male population. Hypertens Res 2013; 36:910-5. [PMID: 23784508 DOI: 10.1038/hr.2013.56] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 03/07/2013] [Accepted: 03/22/2013] [Indexed: 01/10/2023]
Abstract
An enlarged arterial diameter is associated with an increased risk for cardiovascular disease. This study examined the relationship of noninvasively measured brachial artery cross-sectional area with cardiovascular risk factors and arterial stiffness in a middle-aged male population. Absolute volumetric changes of the brachial artery were measured with a newly developed oscillometric method during a general health examination in 387 men (mean age: 38±9 years) without known cardiovascular disease. Based on the measurement, the estimated area (eA) of the brachial artery at end-diastole was obtained. Brachial artery volume elastic modulus (VE) and brachial-ankle pulse wave velocity (baPWV) were simultaneously measured as indices of arterial stiffness by the same device. The relationships of eA with cardiovascular risk factors, including age, obesity, hypertension, dyslipidemia, impaired fasting glucose/diabetes mellitus (IFG/DM), hyperuricemia, smoking and their associated continuous variables, as well as VE and baPWV, were examined. Overall, the mean eA was 12.9 ± 2.9 mm². The eA was significantly higher in subjects with obesity, hypertension or IFG/DM than in those without each of these risk factors. In a multiple linear regression analysis, body mass index (β=0.31, P<0.001), age (β=0.25, P<0.001), systolic blood pressure (β=0.16, P=0.004) and pulse rate (β=-0.13, P=0.005) were independent determinants of eA. In contrast, neither VE nor baPWV were selected as independent determinants of eA. In conclusion, enlarged brachial artery cross-sectional area was significantly associated with cardiovascular risk factors such as age, body mass index and systolic blood pressure, but it was not associated with increased arterial stiffness.
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Affiliation(s)
- Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
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21
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Gullu H, Caliskan M, Caliskan Z, Unler GK, Ermisler E, Ciftci O, Guven A, Muderrisoglu H. Coronary Microvascular function, Peripheral Endothelial Function and Carotid IMT in beta-thalassemia minor. Thromb Res 2013; 131:e247-52. [DOI: 10.1016/j.thromres.2013.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 02/19/2013] [Accepted: 03/14/2013] [Indexed: 01/08/2023]
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22
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Gullu H, Caliskan M, Dursun R, Ciftci O, Guven A, Muderrisoglu H. Impaired coronary microvascular function and its association with disease duration and inflammation in patients with psoriasis. Echocardiography 2013; 30:912-8. [PMID: 23488894 DOI: 10.1111/echo.12156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
SUBJECTS Thirty-six patients with psoriasis and 56 healthy volunteers were included in this study. METHODS Echocardiographic examination included transmitral peak flow velocities of the early phase (E) and late phase (A) of the mitral inflow, left ventricular myocardial velocity measurements, and coronary flow reserve (CFR) measurement. RESULTS Baseline coronary diastolic peak flow velocity (DPFV) of left anterior descending artery (LAD) was significantly higher in the psoriasis group. However, hyperemic DPFV was slightly lower and CFR (2.19 ± 0.39 vs. 2.60 ± 0.31, P < 0.0001) was significantly lower in the psoriasis group than in the control group. CFR was significantly and inversely correlated with disease duration, Psoriasis Area and Severity Index (PASI) score, and hsCRP. CONCLUSION CFR is decreased in patients with psoriasis, and it correlates to disease duration, PASI score, and inflammation.
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Affiliation(s)
- Hakan Gullu
- Cardiology Department, Adana Teaching and Medical Research Center, Baskent University, Adana, Turkey
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23
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Elbasan Z, Şahin D, Gür M, Gözübüyük G, Akıllı RE, Koyunsever NY, Türkoğlu C, Kıvrak A, Yıldırım A, Çaylı M. Aortic distensibility and extent and complexity of coronary artery disease in patients with stable hypertensive and nonhypertensive coronary artery disease. Med Princ Pract 2013; 22:260-4. [PMID: 23327860 PMCID: PMC5586749 DOI: 10.1159/000345842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 11/13/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the relationship between aortic distensibility (AD) and the extent and complexity of atherosclerotic lesions assessed with SYNTAX score (SS) in patients with stable coronary artery disease. SUBJECTS AND METHODS Three hundred and seventy-six consecutive patients (230 males and 146 females; mean age: 61.6 ± 9.9 years) with angiographically proven coronary artery disease were included in the study. The SS was calculated using the SS algorithm on the baseline diagnostic angiogram in the 376 patients. AD was calculated from the echocardiographically derived ascending aorta diameters and hemodynamic pressure measurements in all patients. Frequencies of risk factors, biochemical and hematological data were recorded. The patients were divided into two groups according to the median AD value as AD(low) and AD(high) groups. RESULTS The SS was higher in the AD(low) group compared with the AD(high) group (18.5 ± 10.2 vs. 8.3 ± 5.9, p < 0.001). The AD was independently related to age (β = -0.104, p = 0.019), hypertension (β = -0.202, p < 0.001) and SS (β = -0.457, p < 0.001) and was more strongly associated with SS in hypertensive patients compared to nonhypertensive patients (r = -0.524 vs. r = -0.414, p < 0.001 for all). CONCLUSION The findings showed that impaired AD might be an independent predictor for the severity of coronary atherosclerosis, particularly in patients with hypertension.
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Affiliation(s)
| | - DurmuşYıldıray Şahin
- *Durmuş Yıldıray Şahin, Department of Cardiology, Adana Numune Education and Research Hospital, TR-01170 Adana (Turkey), E-Mail
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24
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Elbasan Z, Sahin DY, Gür M, Kalkan GY, Yıldız A, Kaya Z, Kıvrak A, Gözübüyük G, Özdoğru I, Çaylı M. Aortic distensibility and aortic intima-media thickness in patients without clinical manifestation of atherosclerotic cardiovascular disease. Echocardiography 2012; 30:407-13. [PMID: 23227955 DOI: 10.1111/echo.12066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is growing evidence that aortic distensibility (AD) is a subclinical marker of early atherosclerosis. Aortic intima-media thickness (IMT) was an earlier marker than carotid IMT of preclinical atherosclerosis. In this study, we aimed to assess the relationship between thoracic aortic IMT and AD. METHODS We studied 192 patients (mean age: 45.5 ± 8.4 years) who underwent transesophageal echocardiography (TEE) for various indications. Four different grades were determined according to IMT of thoracic aorta (Grade 1 < 1 mm; 1 mm ≤ Grade 2 < 3 mm; 3 mm ≤ Grade 3 < 5 mm; 5 mm ≤ Grade 4). AD was calculated from the echocardiographically derived ascending aorta diameters and hemodynamic pressure measurements in all patients. High sensitive C-reactive protein (hsCRP) and other biochemical markers were measured using an automated chemistry analyzer. RESULTS TEE evaluation characterized thoracic aortic intimal morphology as grade 1 in 71 patients (37%), grade 2 in 57 patients (29.7%), grade 3 in 34 patients (17.7%), and grade 4 in 30 (15.6%) patients. The lowest AD level was observed in grade 4 group compared with grade 1 and grade 2 groups (P < 0.001, P = 0.009, respectively). AD level of grade 3 group was lower than grade 1 and grade 2 group (P < 0.001, P = 0.021, respectively). In multiple linear regression analysis, AD was independently associated with age (β = -0.138, P = 0.029), hsCRP (β = -0.209, P = 0.001), and aortic IMT (β = -0.432, P < 0.001). CONCLUSION AD is independently associated with age, thoracic aortic IMT, and hsCRP. Impaired elasticity index of the aorta might be an independent predictor for the severity of thoracic atherosclerosis.
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Affiliation(s)
- Zafer Elbasan
- Department of Cardiology, Adana Numune Education and Research Hospital, Adana, Turkey
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Kiattisunthorn K, Moe SM. Chronic Kidney Disease-Mineral Bone Disorder: Definitions and Rationale for a Systemic Disorder. Clin Rev Bone Miner Metab 2012. [DOI: 10.1007/s12018-011-9119-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Yılmaz S, Caliskan M, Kulaksızoglu S, Ciftci O, Caliskan Z, Gullu H, Guven A, Muderrisoglu H. Association between serum total antioxidant status and coronary microvascular functions in patients with SLE. Echocardiography 2012; 29:1218-23. [PMID: 22931164 DOI: 10.1111/j.1540-8175.2012.01797.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Mortality from cardiovascular disease has been found to be increased in patients with systemic lupus erythematosus (SLE). Coronary flow reserve (CFR) measurement is used both to assess epicardial coronary arteries and to examine the integrity of coronary microvascular circulation. Oxidative stress, enhancing modification of plasma lipids, is also associated with atherosclerotic events in lupus patients. Impairment of CFR and TAS has been shown to be an early manifestation of coronary atherosclerosis. Forty patients with SLE and 33 healthy volunteers were included in this study. Echocardiographic examination included left ventricular myocardial velocity measurements and coronary flow reserve (CFR) measurement. Serum total antioxidant status levels (TAS) also were measured using TAS kit. Lateral myocardial early peak velocity (Em) and lateral Em/Am ratio did not differ between the groups, but lateral myocardial atrial peak velocity (Am) was significantly higher in SLE group than the control group. Baseline coronary diastolic peak flow velocity (DPFV) of left anterior descending was similar in both the groups. However, hyperemic DPFV and CFR (2.50 ± 0.42 vs. 3.09 ± 0.45, P < 0.0001) were significantly lower in the SLE group than in the control group. CFR significantly and inversely correlated with CRP and significantly correlated with TAS. Subclinical coronary microvascular dysfunction can occur in SLE patients without traditional cardiovascular risk factors, probably associated with underlying inflammation and impairment of TAS.
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Affiliation(s)
- Sema Yılmaz
- Rheumatology Department, Medical Faculty, Selcuk University, Konya, Turkey
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27
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Abstract
Rheumatoid arthritis, as well as other types of arthritides and connective tissue diseases, is associated with accelerated atherosclerosis, and increased cardiovascular morbidity and mortality. The early signs of cardiovascular disease therefore need to be recognized in patients with these conditions so that effective cardiovascular protection can be introduced. This Review provides an overview of validated techniques that are currently available to determine subclinical atherosclerosis in patients with rheumatic conditions. Techniques for early assessment of endothelial dysfunction include brachial artery flow-mediated vasodilation and laser Doppler flowmetry. Coronary circulation can be assessed by measuring coronary flow reserve using CT, MRI or PET based techniques. The standard indicators of arterial stiffness are pulse-wave velocity and the augmentation index. Carotid atherosclerosis is determined by the common carotid intima-media thickness (ccIMT) measurement or by the assessment of plaques and plaque areas. The combination of ccIMT with plaque assessment is likely to increase the predictive value of this approach. The potential use of a multimarker approach to increase the diagnostic and prognostic value of these clinical assessments is also discussed.
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Gümrükçüoğlu HA, Arı E, Akyol A, Akdağ S, Şimşek H, Şahin M, Güneş Y, Tuncer M. Effects of lowering dialysate sodium on carotid artery atherosclerosis and endothelial dysfunction in maintenance hemodialysis patients. Int Urol Nephrol 2012; 44:1833-9. [DOI: 10.1007/s11255-011-0117-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 12/22/2011] [Indexed: 10/14/2022]
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Correlations between left ventricular mass index and cerebrovascular lesion. Open Med (Wars) 2011. [DOI: 10.2478/s11536-011-0019-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AbstractLeft ventricular (LV) mass and LV geometry are well-established measures of hypertension chronicity and severity, have a prognostic value on cardiovascular morbidity and mortality, and are related to asymptomatic cerebral small-artery disease (SAD) and largeartery disease (LAD). The aim of the present study was to clarify the different effects of LV mass and LV geometry on underlying SAD compared with its effects on underlying LAD in ischemic stroke patients. Four hundred three ischemic stroke patients underwent echocardiography to determine LV mass index and relative wall thickness. Brain magnetic resonance imaging, angiography, and carotid magnetic resonance angiography were preformed to detect LAD (≥50% stenosis) and SAD (leukoaraiosis, microbleeds, and old lacunar infarction) in the brain. Multivariate analyses showed that the LV mass index was highly associated with underlying SAD but not with underlying LAD. Among the various subtypes of SAD, only cerebral microbleeds were closely related to the LV mass index. Concentric LV hypertrophy was not related to the presence of either SAD or LAD. Subgroup analyses revealed that, among the various subtypes of SAD, only cerebral microbleeds were associated with concentric LV hypertrophy. In conclusion, cerebral microbleeds may imply more advanced target organ damage than underlying LAD and ischemic subtypes of SAD.
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Mahfouz RA, El Tahlawi MA, Ateya AA, Elsaied A. Early Detection of Silent Ischemia and Diastolic Dysfunction in Asymptomatic Young Hypertensive Patients. Echocardiography 2011; 28:564-9. [DOI: 10.1111/j.1540-8175.2011.01388.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Vladimirova-Kitova LG, Deneva-Koicheva TI. Increased Intima-Media Thickness in Carriers of the LDL-Receptor Defective Gene versus Noncarriers with Newly Detected Asymptomatic Severe Hypercholesterolemia. Echocardiography 2011; 28:223-34. [DOI: 10.1111/j.1540-8175.2010.01304.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Gunes Y, Tuncer M, Guntekin U, Ceylan Y, Simsek H, Sahin M, Yildirim M. The relation between the color M-mode propagation velocity of the descending aorta and coronary and carotid atherosclerosis and flow-mediated dilatation. Echocardiography 2010; 27:300-5. [PMID: 20486958 DOI: 10.1111/j.1540-8175.2009.01019.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To improve clinical outcomes, noninvasive imaging modalities have been proposed to measure and monitor atherosclerosis. Common carotid intima-media thickness (CIMT) and brachial artery flow-mediated dilatation (FMD) have correlated with coronary atherosclerosis. Recently, the color M-mode-derived propagation velocity of descending thoracic aorta (AVP) was shown to be associated with coronary artery disease (CAD). METHODS CIMT, FMD, and AVP were measured in 92 patients with CAD and 70 patients having normal coronary arteries (NCA) detected by coronary angiography. Patients with acute myocardial infarction, renal failure or hepatic failure, aneurysm of aorta, severe valvular heart disease, left ventricular ejection fraction <40%, atrial fibrillation, frequent premature beats, left bundle branch block, and inadequate echocardiographic image quality were excluded. RESULTS Compared to patients with normal coronary arteries, patients having CAD had significantly lower AVP (29.9 +/- 8.1 vs. 47.5 +/- 16.8 cm/sec, P < 0.001) and FMD (5.3 +/- 1.9 vs. 11.4 +/- 5.8%, P < 0.001) and higher CIMT (0.94 +/- 0.05 vs. 0.83 +/- 0.14 mm, P < 0.001) measurements. There were significant correlations between AVP and CIMT (r =-0.691, P < 0.001), AVP and FMD (r = 0.514, P < 0.001) and FMD and CIMT (r =-0.530, P < 0.001). CONCLUSIONS The transthoracic echocardiographic determination of the color M-mode propagation velocity of the descending aorta is a simple practical method and correlates well with the presence of carotid and coronary atherosclerosis and brachial endothelial function.
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Affiliation(s)
- Yilmaz Gunes
- Cardiology Department, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey. mail:
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Guntekin U, Gunes Y, Gunes A, Ceylan Y, Gumrukcuoglu HA, Yucel Y, Simsek H, Tuncer M. Noninvasive Assessment of Atherosclerosis in Patients with Isolated Hypertension. Echocardiography 2010; 27:155-60. [DOI: 10.1111/j.1540-8175.2009.00987.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Abela GS. Role of cholesterol crystals in myocardial infarction and stroke. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/clp.09.79] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Vittorio TJ, Lanier G, Zolty R, Sarswat N, Tseng CH, Colombo PC, Jorde UP. Association between endothelial function and chronotropic incompetence in subjects with chronic heart failure receiving optimal medical therapy. Echocardiography 2010; 27:294-9. [PMID: 20070352 DOI: 10.1111/j.1540-8175.2009.01011.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Impairment of flow-mediated, endothelium-dependent vasodilatation (FMD) of the brachial artery identifies peripheral endothelial dysfunction in subjects with chronic congestive heart failure (CHF) and is associated with increased morbidity and mortality. To further elucidate the interaction of peripheral and central mechanisms in the syndrome of CHF, we examined the association between endothelial function and chronotropic incompetence, an emerging prognostic marker in CHF. METHODS Thirty subjects with stable New York Heart Association (NYHA) functional class II-III CHF were studied. A vascular ultrasound study was performed to measure brachial artery FMD. The percentage of age-adjusted maximal predicted heart rate (MPHR) reached during cardiopulmonary exercise tolerance testing (CPETT) was used to assess the degree of chronotropic competence. All patients received ACE inhibitors and beta-adrenoceptor blockers. RESULTS Brachial artery FMD averaged 1.3 +/- 2.4% and age-adjusted % MPHR 74.1 +/- 11.7%. FMD correlated with % MPHR among all patients (r = 0.60, P = 0.01). FMD and resting heart rate (RHR) did not significantly correlate (r = 0.13, P = 0.55). CONCLUSIONS FMD, a measure of peripheral endothelial dysfunction, and % MPHR, a central determinant of cardiac output, are moderately correlated in heart failure patients receiving optimal medical therapy. Whether a cause-effect relationship underlies this association remains to be investigated.
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Affiliation(s)
- Timothy J Vittorio
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY 10029-6574, USA
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Urbina EM, Khoury P, Martin LJ, D'Alessio D, Dolan LM. Gender differences in the relationships among obesity, adiponectin and brachial artery distensibility in adolescents and young adults. Int J Obes (Lond) 2009; 33:1118-25. [PMID: 19704412 PMCID: PMC2768126 DOI: 10.1038/ijo.2009.164] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Obesity-related cardiovascular diseases (CVDs) are a major cause of cardiovascular (CV) mortality. Obesity-related reduction in vascular protective adipose-derived proteins, such as adiponectin (APN), has an important role. METHODS We compared brachial artery distensibility (BrachD) with APN, the level of adiposity and other CV risk factors (CVRFs) in 431 post-pubertal subjects (mean 17.9 years). Gender differences in average values were examined by t-tests. Correlations among BrachD, obesity and other CVRFs were examined. Regression analysis was performed to determine whether APN provided an independent contribution to BrachD, while controlling for obesity and other CVRFs. RESULTS Male subjects had lower BrachD (5.72+/-1.37 vs 6.45+/-1.60% change per mm Hg, P<0.0001) and lower APN (10.50+/-4.65 vs 13.20+/-6.53; all P<0.04) than female subjects. BrachD correlated with APN (r=0.25, P< 0.0001). Both BrachD and APN correlated with measures of body size, including height, weight and body mass index (BMI). Both correlated with higher systolic blood pressure, glucose, insulin and lower high-density lipoprotein cholesterol (all P<0.01). In multivariate analysis, APN, gender, APN*gender and BMI z-score predicted BrachD (r(2)=0.305). On the basis of gender difference, only BMI z-score was significant for male subjects (r(2)=0.080), whereas APN and BMI z-score contributed for female subjects (r(2)=0.242, all P<0.0001). CONCLUSIONS BrachD is independently influenced by obesity in both male and female subjects. In female subjects, APN exerts an additional independent effect even after adjusting for blood pressure (BP), lipid levels and insulin. Differences in the effect of the APN-adiposity relationship on obesity-related vascular disease may be one reason for gender differences in the development and progression of atherosclerosis.
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Affiliation(s)
- E M Urbina
- Division of Preventive Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Holewijn S, den Heijer M, Swinkels DW, Stalenhoef AFH, de Graaf J. Brachial artery diameter is related to cardiovascular risk factors and intima-media thickness. Eur J Clin Invest 2009; 39:554-60. [PMID: 19453648 DOI: 10.1111/j.1365-2362.2009.02152.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous reports showed inconsistent results about the potential role of flow-mediated dilatation (FMD) in cardiovascular(CV) risk prediction. Few data are available about the role of nitroglycerin-mediated dilatation (NMD), but recently, brachial artery diameter(BAD) appeared to have predictive value in CV risk prediction.We determined the relation of FMD, BAD and NMD with known CV risk factors and intima-media thickness (IMT), a well-established surrogate marker of atherosclerosis, in a community-based population, the Nijmegen Biomedical Study (NBS). MATERIALS AND METHODS FMD, BAD and NMD were measured in the brachial, and IMT in the common carotid artery ultrasononically in 337 participants, aged 50-70 years. Traditional clinical and biochemical parameters were determined. RESULTS Both FMD and NMD were not correlated with most CV risk factors or prevalent CVD. However, both IMT and BAD did show significant correlations with CV risk factors. In accordance, both IMT and BAD were significantly correlated with prevalent CVD (r=0.62 and r=-0.37, respectively) . Furthermore, FMD was not correlated with IMT and did hardly (R2=1.1%) improve the prediction of IMT by CV risk factors in regression analysis. However, both BAD and NMD did correlate with IMT (r=-0.29 and r=0.25, respectively). CONCLUSION In our study, FMD and NMD were not related to known CV risk factors and prevalent CVD, and FMD was not correlated with IMT, a surrogate marker of atherosclerosis. Most intriguingly, BAD was significantly correlated with some CV risk factors, prevalent CVD and IMT. So, BAD is a potential valuable tool in CV risk prediction in middle-aged low-risk populations, whereas FMD is not.
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Affiliation(s)
- S Holewijn
- Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Tanasescu C, Jurcut C, Jurcut R, Ginghina C. Vascular disease in rheumatoid arthritis: from subclinical lesions to cardiovascular risk. Eur J Intern Med 2009; 20:348-54. [PMID: 19524171 DOI: 10.1016/j.ejim.2008.09.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Revised: 07/31/2008] [Accepted: 09/04/2008] [Indexed: 12/13/2022]
Abstract
Rheumatoid arthritis (RA) is one of the most prevalent and complex inflammatory diseases affecting primarily the joints, but also associating several extra-articular features. The vascular disease in RA encompasses a large spectrum of lesions, from rheumatoid vasculitis to atherosclerotic lesions. During the last years the importance of the vascular disease related to atherosclerosis in terms of cardiovascular morbidity and global mortality became evident in RA. The inflammatory hypothesis of atherosclerosis in RA implies that mediators originating from the inflamed synovial tissue or from the liver may have systemic vascular consequences, leading to endothelial dysfunction and structural abnormalities of the vessels. Hence, the global management of patients with RA must include the improvement of cardiovascular risk in parallel with the management of joint disease.
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Affiliation(s)
- Coman Tanasescu
- Department of Internal Medicine, Colentina Clinical Hospital, Bucharest, Romania.
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Mani V, Muntner P, Gidding SS, Aguiar SH, El Aidi H, Weinshelbaum KB, Taniguchi H, van der Geest R, Reiber JHC, Bansilal S, Farkouh M, Fuster V, Postley JE, Woodward M, Fayad ZA. Cardiovascular magnetic resonance parameters of atherosclerotic plaque burden improve discrimination of prior major adverse cardiovascular events. J Cardiovasc Magn Reson 2009; 11:10. [PMID: 19393089 PMCID: PMC2680849 DOI: 10.1186/1532-429x-11-10] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 04/24/2009] [Indexed: 02/08/2023] Open
Abstract
AIMS Patients with prior major cardiovascular or cerebrovascular events (MACE) are more likely to have future recurrent events independent of traditional cardiovascular disease risk factors. The purpose of this study was to determine if patients with traditional risk factors and prior MACE had increased cardiovascular magnetic resonance (CMR) plaque burden measures compared to patients with risk factors but no prior events. METHODS AND RESULTS Black blood carotid and thoracic aorta images were obtained from 195 patients using a rapid extended coverage turbo spin echo sequence. CMR measures of plaque burden were obtained by tracing lumen and outer vessel wall contours. Patients with prior MACE had significantly higher MR plaque burden (wall thickness, wall area and normalized wall index) in carotids and thoracic aorta compared to those without prior MACE (Wall thickness carotids: 1.03 +/- 0.03 vs. 0.93+/- 0.03, p = 0.001; SD wall thickness carotids: 0.137 +/- 0.0008 vs. 0.102 +/- 0.0004, p < 0.001; wall thickness aorta: 1.63 +/- 0.10 vs. 1.50 +/- 0.04, p = 0.009; SD wall thickness aorta: 0.186 +/- 0.035 vs. 0.139 +/- 0.012, p = 0.009 respectively). Plaque burden (wall thickness) and plaque eccentricity (standard deviation of wall thickness) of carotid arteries were associated with prior MACE after adjustment for age, sex, and traditional risk factors. Area under ROC curve (AUC) for discriminating prior MACE improved by adding plaque eccentricity to models incorporating age, sex, and traditional CVD risk factors as model inputs (AUC = 0.79, p = 0.05). CONCLUSION A greater plaque burden and plaque eccentricity is prevalent among patients with prior MACE.
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Affiliation(s)
- Venkatesh Mani
- Imaging Science Laboratories; Translational and Molecular Imaging Institute, Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA
| | - Paul Muntner
- Department of Community Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | | | - Silvia H Aguiar
- Imaging Science Laboratories; Translational and Molecular Imaging Institute, Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA
| | - Hamza El Aidi
- Imaging Science Laboratories; Translational and Molecular Imaging Institute, Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA
| | - Karen B Weinshelbaum
- Imaging Science Laboratories; Translational and Molecular Imaging Institute, Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA
| | - Hiroaki Taniguchi
- Imaging Science Laboratories; Translational and Molecular Imaging Institute, Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA
| | | | | | - Sameer Bansilal
- Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Michael Farkouh
- Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Valentin Fuster
- Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | | | - Mark Woodward
- Department of Community Medicine, Mount Sinai School of Medicine, New York, NY, USA
- Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Zahi A Fayad
- Imaging Science Laboratories; Translational and Molecular Imaging Institute, Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA
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Clinical study of the ascending aorta wall motion by velocity vector imaging in patients with primary hypertension. ACTA ACUST UNITED AC 2009; 29:127-30. [DOI: 10.1007/s11596-009-0127-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Indexed: 10/19/2022]
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Kiotsekoglou A, Moggridge JC, Kapetanakis V, Newey VR, Kourliouros A, Mullen MJ, Kaski JC, Nassiri DK, Camm J, Sutherland GR, Child AH. Assessment of carotid compliance using real time vascular ultrasound image analysis in Marfan syndrome. Echocardiography 2008; 26:441-51. [PMID: 19054030 DOI: 10.1111/j.1540-8175.2008.00813.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Fibrillin-1 deficiency, dysregulated cytokine transforming growth factor-beta, and increased collagen deposition related to fibrillin-1 gene mutations could predispose to impaired carotid compliance (CC) in Marfan syndrome (MFS). We sought to detect any alterations in CC using the vascular image analysis system (VIA). METHODS AND RESULTS Thirty-two MFS patients, 20 men and 12 women (mean age 34.2 +/- 12.05 years), and 29 controls matched for age, sex, and body surface area (BSA) were recruited. The entire length of each carotid system was initially scanned longitudinally using a 14 MHz linear transducer. Then, a stereotactic clamp held the transducer in contact with the carotid artery. Arterial diameter changes during the cardiac cycle were recorded for 1 minute from both right (RCCA) and left common carotid arteries (LCCA) separately using the VIA system. RCCA and LCCA compliance and distensibility measurements were significantly reduced in MFS patients when compared to controls, P < 0.05. RCCA and LCCA intima-media thickness did not differ between patients and controls, P > 0.05. MFS diagnosis and age were associated with reduced CC in both carotid arteries after adjusting for variables such as, sex, BSA, heart rate, beta-blockade, intima-media thickness, and aortic root size. CONCLUSIONS Our findings showed a reduction in CC in adult patients with MFS. This could be attributed to fibrillin-1 deficiency resulting in structural abnormalities in the carotid arterial wall.
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Affiliation(s)
- Anatoli Kiotsekoglou
- Department of Cardiac and Vascular Sciences, St. George's, University of London, Cranmer Terrace, London, UK
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Çelik Ş, Durmuş İ, Korkmaz L, Gedikli Ö, Kaplan Ş, Örem C, Baykan M. Aortic Pulse Wave Velocity in Subjects with Aortic Valve Sclerosis. Echocardiography 2008; 25:1112-6. [DOI: 10.1111/j.1540-8175.2008.00728.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Walker M, Campbell BR, Azer K, Tong C, Fang K, Cook JJ, Forrest MJ, Kempadoo K, Wright SD, Saltzman JS, MacIntyre E, Hargreaves R. A novel 3-dimensional micro-ultrasound approach to automated measurement of carotid arterial plaque volume as a biomarker for experimental atherosclerosis. Atherosclerosis 2008; 204:55-65. [PMID: 19135672 DOI: 10.1016/j.atherosclerosis.2008.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Revised: 08/23/2008] [Accepted: 09/01/2008] [Indexed: 10/21/2022]
Abstract
Improved methods for non-invasive in vivo assessment are needed to guide development of animal models of atherosclerosis and to evaluate target engagement and in vivo efficacy of new drugs. Using novel 3D-micro-ultrasound technology, we developed and validated a novel protocol for 3D acquisition and analysis of imaging to follow lesion progression in atherosclerotic mice. The carotid arteries of ApoE receptor knockout mice and normal control mice were imaged within the proximal 2mm from the aortic branch point. Plaque volume along that length was quantified using a semi-automated 3D segmentation algorithm. Volumes derived by this method were compared to those calculated using 3-D histology post-mortem. Bland-Altman comparison revealed close correlation between these two measures of plaque volume. Furthermore, using a segmentation technique that captures early positive and 33 week negative remodeling, we found evidence that plaque volume increases linearly over time. Each animal and each plaque served as its own control, allowing accurate comparison. The high fidelity anatomical registration of this protocol provides increased spatial resolution and therefore greater sensitivity for measurement of plaque wall size, an advance over 2-dimensional measures of intimal-medial-thickening. Further, 3-dimensional analysis ensures a point of registration that captures functional markers in addition to the standard structural markers that characterize experimental atherosclerosis. In conclusion, this novel imaging protocol provides a non-invasive, accurate surrogate marker for experimental atherosclerosis over the life of the entire lesion.
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Affiliation(s)
- Matthew Walker
- Department of Imaging Research, Merck & Co. Inc., Rahway, NJ 07065, USA. matthew
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Nguyen PK, Meyer C, Engvall J, Yang P, McConnell MV. Noninvasive assessment of coronary vasodilation using cardiovascular magnetic resonance in patients at high risk for coronary artery disease. J Cardiovasc Magn Reson 2008; 10:28. [PMID: 18513419 PMCID: PMC2467421 DOI: 10.1186/1532-429x-10-28] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 05/30/2008] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Impaired coronary vasodilation to both endothelial-dependent and endothelial-independent stimuli have been associated with atherosclerosis. Direct measurement of coronary vasodilation using x-ray angiography or intravascular ultrasound is invasive and, thus, not appropriate for asymptomatic patients or for serial follow-up. In this study, high-resolution coronary cardiovascular magnetic resonance (CMR) was used to investigate the vasodilatory response to nitroglycerine (NTG) of asymptomatic patients at high risk for CAD. METHODS A total of 46 asymptomatic subjects were studied: 13 high-risk patients [8 with diabetes mellitus (DM), 5 with end stage renal disease (ESRD)] and 33 age-matched controls. Long-axis and cross-sectional coronary artery images were acquired pre- and 5 minutes post-sublingual NTG using a sub-mm-resolution multi-slice spiral coronary CMR sequence. Coronary cross sectional area (CSA) was measured on pre- and post-NTG images and % coronary vasodilation was calculated. RESULTS Patients with DM and ESRD had impaired coronary vasodilation to NTG compared to age-matched controls (17.8 +/- 7.3% vs. 25.6 +/- 7.1%, p = 0.002). This remained significant for ESRD patients alone (14.8 +/- 7.7% vs. 25.6 +/- 7.1%; p = 0.003) and for DM patients alone (19.8 +/- 6.3% vs. 25.6 +/- 7.1%; p = 0.049), with a non-significant trend toward greater impairment in the ESRD vs. DM patients (14.8 +/- 7.7% vs. 19.8 +/- 6.3%; p = 0.23). CONCLUSION Noninvasive coronary CMR demonstrates impairment of coronary vasodilation to NTG in high-risk patients with DM and ESRD. This may provide a functional indicator of subclinical atherosclerosis and warrants clinical follow up to determine prognostic significance.
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Affiliation(s)
- Patricia K Nguyen
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, USA
| | - Craig Meyer
- Department of Biomedical Engineering, University of Virginia, Virginia, USA
| | - Jan Engvall
- Department of Clinical Physiology, Linköping Heart Center, Linköping, Sweden
| | - Phillip Yang
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, USA
| | - Michael V McConnell
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, USA
- Department of Electrical Engineering, Stanford University, Stanford, USA
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Simova I, Nossikoff A, Denchev S. Interobserver and intraobserver variability of flow-mediated vasodilatation of the brachial artery. Echocardiography 2008; 25:77-83. [PMID: 18186783 DOI: 10.1111/j.1540-8175.2007.00552.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Flow-mediated endothelial-dependent vasodilatation (FMD) of the brachial artery is a method capable of detecting endothelial dysfunction. In order to implement this method in future clinical research studies, its reproducibility and precision have to be assessed. The aim of the study is to evaluate the inter- and intraobserver variability of FMD performed in our department. We investigate 40 patients. FMD is measured by two independent observers to test the interobserver variability, and repeated by the first observer to test the intraobserver variability. We compare the baseline and post-ischemic diameter of the brachial artery and the percent dilatation. The correlation coefficients for these comparisons are high (>0.92) with a significance of less than 0.001. The inter- and intraobserver variability is further tested comparing the mean values of the baseline and post ischemic diameter of the brachial artery and the percent dilatation. The absolute values of the mean paired differences and the standard deviations (SDs) of the differences are 0.02850 +/- 0.05942, P = 0.004, 0.01175 +/- 0.08177, P = 0.369 and 0.28375 +/- 1.61561, P = 0.273, respectively for the interobserver variability and 0.00475 +/- 0.04663, P = 0.523, 0.00050 +/- 0.05267, P = 0.952 and 0.15725 +/- 1.19922, P = 0.412, respectively for the intraobserver variability. It can be concluded that the inter- and intraobserver variability for FMD performed in our department is acceptable. FMD can be performed precisely and accurately, with a satisfactory reproducibility and can be safely and reliably implemented in future clinical research studies.
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Affiliation(s)
- Iana Simova
- Clinic of Cardiology, University Hospital "Alexandrovska", Sofia, Bulgaria.
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Martins WP, Nastri CO, Ferriani RA, Filho FM. Brachial artery pulsatility index change 1 minute after 5-minute forearm compression: comparison with flow-mediated dilatation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:693-699. [PMID: 18424643 DOI: 10.7863/jum.2008.27.5.693] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Endothelial impairment evaluation by sonographic measurement of flow-mediated dilatation (FMD) has become broadly used. However, this method has 2 main caveats: the dilatation depends on the baseline arterial diameter, and a high precision level is required. Vasodilatation leads to an amplified fall in impedance. We hypothesized that assessment of the pulsatility index change (PI-C) 1 minute after 5-minute forearm compression might evaluate that fall in impedance. The aim of this study was to compare the PI-C with FMD. METHODS Flow-mediated dilatation and the PI-C were assessed in 51 healthy women aged between 35.1 and 67.1 years. We correlated both FMD and the PI-C with age, body mass index, waist circumference, cholesterol level, high-density lipoprotein level, glucose level, systolic and diastolic blood pressure, pulse pressure, brachial artery diameter, simplified Framingham score, intima-media thickness, and carotid stiffness index. Intraclass correlation coefficients between 2 FMD and PI-C measurements were also examined. RESULTS Only FMD correlated with baseline brachial diameter (r = -0.53). The PI-C had a high correlation with age, body mass index, waist circumference, cholesterol level, systolic blood pressure, pulse pressure, simplified Framingham score, and intima-media thickness. The correlation between FMD and the PI-C was high (r = -0.66). The PI-C had a higher intraclass correlation coefficient (0.991) than FMD (0.836) but not brachial artery diameter (0.989). CONCLUSIONS The PI-C had a large correlation with various markers of cardiovascular risk. Additionally, PI-C measurement does not require offline analysis, extra software, or electrocardiography. We think that the PI-C could be considered a marker of endothelial function. However, more studies are required before further conclusions.
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Affiliation(s)
- Wellington P Martins
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, 14049-900 São Paulo-SP, Brazil.
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Kiviniemi T. Assessment of coronary blood flow and the reactivity of the microcirculation non-invasively with transthoracic echocardiography. Clin Physiol Funct Imaging 2008; 28:145-55. [DOI: 10.1111/j.1475-097x.2008.00794.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Ciftci O, Yilmaz S, Topcu S, Caliskan M, Gullu H, Erdogan D, Pamuk BO, Yildirir A, Muderrisoglu H. Impaired coronary microvascular function and increased intima-media thickness in rheumatoid arthritis. Atherosclerosis 2007; 198:332-7. [PMID: 18164712 DOI: 10.1016/j.atherosclerosis.2007.11.013] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Revised: 10/03/2007] [Accepted: 11/15/2007] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is associated with excessive cardiovascular mortality. Recently, some studies have shown endothelial dysfunction in RA patients with high inflammatory activity. In addition, it has been suggested that the chronic inflammatory state of RA contributes to accelerated atherosclerosis. Therefore, we aimed to evaluate whether coronary microvascular dysfunction and increased carotid artery intima-media thickness exist in patients with a long history and well controlled disease activity of RA lacking traditional cardiovascular risk factors. METHODS Thirty RA patients (22 women; mean age 43.7+/-9.0) and 52 healthy volunteers (38 women; mean age 45.3+/-5.4) were included into the study. Using transthoracic echocardiography, each subject underwent echocardiographic examination including coronary flow reserve (CFR) and carotid intima-media thickness (IMT) measurement. RESULTS CFR values were statistically reduced for RA patients as compared to controls (2.4+/-0.5 vs. 2.7+/-0.4, P=0.002) whereas IMT values were significantly increased (0.6+/-0.1 vs. 0.5+/-0.1, P=0.001). In RA patients, CFR positively correlated with lateral Em/Am ratio (r=0.399, P=0.029), and negatively correlated with lateral isovolumic relaxation time (IVRT) (r=-0.744, P=0.005), IMT (r=-0.542, P=0.002) and RA disease duration (r=-0.495, P=0.005). Reflecting LV diastolic function, mitral E-wave deceleration time and isovolumic relaxation time were borderline significant between the groups, however lateral Em/Am ratio and lateral IVRT were statistically different. CONCLUSIONS Patients with RA had impaired CFR and increased carotid IMT, and these injurious effects correlated significantly with disease duration.
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Affiliation(s)
- Ozgur Ciftci
- Baskent University Medicine Faculty Cardiology, Ankara, Turkey.
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Bigi MAB, Aslani A, Mehrpour M. Effect of Chronic Cocaine Abuse on the Elastic Properties of Aorta. Echocardiography 2007; 25:308-11. [DOI: 10.1111/j.1540-8175.2007.00593.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Gedikli O, Altinbas A, Orucoglu A, Dogan A, Ozaydin M, Aslan SM, Acar G, Canatan D. Elastic Properties of the Ascending Aorta in Patients with ?-Thalassemia Major. Echocardiography 2007; 24:830-6. [PMID: 17767533 DOI: 10.1111/j.1540-8175.2007.00486.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Beta-thalassemia major (beta-TM) is a congenital hemolytic disorder characterized by impaired left ventricular and endothelial function. However, elastic properties of the aorta have not been sufficiently investigated in patients with beta-TM. We investigated whether beta-TM is related to impaired ascending aortic elastic properties. METHODS We studied 36 patients with beta-TM (age: 15.8 +/- 2.6 years) and 30 age- and sex-matched control subjects by echocardiography. Aortic elastic indexes, aortic strain (%), distensibility (cm(2) dyn(-1) 10(-3)), and stiffness index were calculated from the echocardiographically derived thoracic aortic diameters (mm/m(2)), and the measurement of pulse pressure obtained by cuff sphygmomanometry. RESULTS Patients versus control subjects had increased aortic diameters (P < 0.001), lower mean aortic strain (9 +/- 3.6 vs. 14.9 +/- 3.2, P < 0.001) and distensibility (0.6 +/- 0.36 vs. 0.8 +/- 0.2, P < 0.012), and higher mean stiffness index (5.3 +/- 2.4 vs. 2.8 +/- 0.6, P < 0.001). Aortic elastic indexes were significantly associated with ferritin level, while stiffness index was significantly related to platelet count. CONCLUSION Elastic properties of ascending aorta are impaired in patients with beta-TM. Impaired functions of aorta may lead to deterioration of left ventricular function.
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Affiliation(s)
- Omer Gedikli
- Department of Cardiology, Sevket Demirel Heart Center, Suleyman Demirel University, Isparta, Turkey
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