Coronary Artery Disease and Endothelial Dysfunction: Novel Diagnostic and Therapeutic Approaches

Oikonomou, Evangelos; Siasos, Gerasimos; Tsigkou, Vasiliki; Bletsa, Evanthia; Panoilia, Maria-Evi; Oikonomou, I; Simanidis, Ilias; Spinou, Marianna; Papastavrou, Angeliki; Kokosias, Georgios; Zaromitidou, Marina; Stampouloglou, Panagiota K.; Spartalis, Μichael; Vavuranakis, Μanolis; Stefanadis, Christodoulos; Papavassiliou, Athanasios G.; Tousoulis, Dimitris

doi:10.2174/0929867326666190830103219

Cited by 36 publications

(19 citation statements)

References 170 publications

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“…Инвазивная коронарография Стеноз 75-100% [19]. Нельзя также исключить, что аналогичные нарушения обусловлены наличием гиперхолестеринемии даже без какой-либо выявляемой коронарной болезни [10].…”

Section: метод анализа перфузии миокардаunclassified

Haracteristics of Myocardial Blood Flow and Coronary Flow Reserve by Pet/Ct in Patients With Coronary Artery Disease With Different Degrees of Coronary Artery Stenosis

Golukhova¹,

Shavman²,

Shurupova³

et al. 2021

Rejr

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ФГБУ «Национальный медицинский исследовательский центр сердечно-сосудистой хирургии имени А.Н. Бакулева» Минздрава России.г. Москва, Россия ель исследования. Выявление и дальнейший анализ различий количественных величин миокардиального кровотока по данным позитронно-эмиссионной томографии, совмещенной с компьютерной томографией (ПЭТ/КТ), в группах коронарных артерий (КА) с различной степенью стенозов у больных ИБС. Материалы и методы. Обследовано 122 пациента (102 с ИБС, 20 -здоровые), которым выполнены инвазивная коронарография и стресс-ПЭТ/КТ с 13N-аммонием в динамическом режиме с определением величины регионарного коронарного резерва и миокардиального кровотока, проведено их сравнение в группах артерий: 1) со значительными стенозами (75-100%, n=99); 2) пограничными (50-74%, n=101); 3) интактных артерий группы ИБС (стеноз 0-40%, n=106); 4) здоровых пациентов (n=60).Результаты. Коронарный резерв и миокардиальный кровоток нагрузки значимо ниже (p <0,001) в группе артерий со стенозами ≥75% по сравнению со всеми (2-й, 3-й и 4-й) группами артерий. По этим же показателям группы артерий с пограничными стенозами и интактными артериями больных с ИБС не различались (p >0,05). В тоже время, резерв и кровоток нагрузки был значимо ниже в группе интактных артерий больных ИБС по сравнению с интактными артериями здоровых пациентов. Информативность показателя коронарного резерва в диагностике стенозов различных градаций превосходила информативность кровотока нагрузки. При этом чувствительность, специфичность и точность коронарного резерва избирательно для пограничных стенозов составила 45%, 80% и 67%; для выраженных стенозов (75-100%) -85%, 80% и 82% соответственно.Заключение. Количественные показатели кровотока по данным стресс-ПЭТ/КТ миокарда обладают высокой чувствительностью и специфичностью в диагностике стенозов высоких градаций. Субоптимальная чувствительность и точность метода в диагностике пограничных стенозов предположительно связаны с низкой долей гемодинамически значимых изменений в данной группе. По сравнению с артериями здоровых пациентов более низкие величины миокардиального кровотока в интактных артериях больных ИБС могут быть обусловлены наличием микроваскулярной дисфункции.Ключевые слова: миокардиальный кровоток, коронарный резерв, ПЭТ/КТ миокарда, количественная оценка кровотока.

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Section: метод анализа перфузии миокардаunclassified

Haracteristics of Myocardial Blood Flow and Coronary Flow Reserve by Pet/Ct in Patients With Coronary Artery Disease With Different Degrees of Coronary Artery Stenosis

Golukhova¹,

Shavman²,

Shurupova³

et al. 2021

Rejr

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“…Endothelial function can be non-invasively estimated by flow-mediated dilation (FMD), typically in the brachial artery. It is an established risk factor which independently predicts cardiovascular events [7]. Impaired vascular wall properties, including wave reflection and arterial stiffness, also possess a prognostic capacity for cardiovascular disease and early appearance of reflected waves in systole associates with reduced coronary perfusion [8,9].…”

Section: Introductionmentioning

confidence: 99%

Lipoprotein-associated phospholipase A2 levels, endothelial dysfunction and arterial stiffness in patients with stable coronary artery disease

et al. 2021

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Background Lipoprotein-associated Phospholipase A2 (Lp-PLA2), can exert proinflammatory as well as proatherogenic properties on the vascular wall. The current study sought to evaluate the influence of high Lp-PLA2 levels on indices of arterial wall properties in patients with stable coronary artery disease (CAD). Methods Three hundred seventy-four consecutive patients with stable CAD (mean age 61 ± 11 years, 89% males) were enrolled in this single-center cross-sectional study. Flow-mediated dilation (FMD) was used to assess endothelial function and augmentation index (AIx) of the central aortic pressure was used to assess reflected waves. ELISA was used to determine Lp-PLA2 serum levels. Results After dividing the participants in 3 equal groups based on the tertiles of circulating Lp-PLA2 values, no significant differences were demonstrated between those in the 3rd tertile with Lp-PLA2 values > 138 μg/L, in the 2nd tertile with Lp-PLA2 values between 101 and 138 μg/L and in the 1st tertile (Lp-PLA2 values < 101 μg/L) regarding age, male gender, smoking habits, family history of CAD or history of a previous myocardial infarction, diabetes mellitus, arterial hypertension, hyperlipidemia, duration of CAD and treatment with relevant medication. Importantly, subjects with Lp-PLA2 values in the highest tertile, had significantly reduced FMD values compared to the middle and lower tertile (4.43 ± 2.37% vs. 4.61 ± 1.97% vs. 5.20 ± 2.52% respectively, P = 0.03). Patients in the highest tertile of Lp-PLA2 values had significantly higher AIx values (24.65 ± 8.69% vs. 23.33 ± 9.65%, P = 0.03), in comparison to the lowest tertile, with Lp-PLA2 values < 101 μg/L. A linear regression analysis showed that Lp-PLA2 values > 138 μg/L negatively correlated to FMD [b = − 0.45 (95% CI: − 0.79 – -0.11), P = 0.01] and AIx values [b = 1.81 (95% CI: 0.57–3.05), P < 0.001] independently of cofounders like gender, age, diabetes mellitus, arterial hypertension, dyslipidemia, smoking habits, family history of CAD, history of previous myocardial infarction, serum glucose, circulating lipid levels, duration of CAD, antihypertensive medication, antidiabetic drugs, statin therapy and treatment with β-blockers. Conclusions Elevated Lp-PLA2 levels relate to endothelial dysfunction and arterial stiffness in patients with stable CAD independently from classical risk factors for CAD, statin use, antihypertensive treatment, and duration of the disease.

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“…Undoubtedly, hemostasis plays a critical role in the occurrence and progression of CAD [14,15], which is a pathologic process of coronary arteries narrowing commonly caused by the progression of atherosclerosis with further accumulation of deposits in the vessels walls [2]. It is clearly defined that wellbalanced functioning of the fibrinolytic system provides clots dissolution and maintains vascular patency [16].…”

Section: Introductionmentioning

confidence: 99%

Some fibrinolytic parameters in coronary artery disease patients: focus on unstable angina subgroups

Tyravska

Bondarchuk

Raksha

et al. 2021

EUMJ

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Unstable angina is classified into new-onset, progressive, and angina at rest. Though hemostasis plays a crucial role in the pathogenesis of coronary artery disease, including unstable angina, limited data exist regarding peculiarities of fibrinolytic parameters in the above-mentioned types of unstable angina. Our study aims to investigate if there is a difference in the fibrinolytic state between the groups of patients with new-onset, progressive unstable angina in comparison with stable angina patients depending on medical history data, electrocardiographic and hemodynamic features. In our cross-sectional study, we recruited 93 coronary artery disease patients (mean age 62.32 (6.94) years, 41 males (44.1%)). They were divided into 3 groups: stable angina patients (n=22) (control), new-onset unstable angina patients (n=21), and progressive unstable angina patients (n=50). The groups were comparable by baseline characteristics. Blood samples were obtained before treatment onset. The concentrations of tissue plasminogen activator and inhibitor of plasminogen activator (type 1) were measured by the ELISA method. We registered 14 points at the admission department, particularly age, sex, body mass index, smoking, presence of the family history of cardiovascular disorders, ST-segment depression, T-wave variability, arrhythmias, left bundle branch blockage, heart rate, systolic and diastolic blood pressure, Sokolov-Lyon voltage criteria, and unstable angina type (new-onset or progressive). After comparison of fibrinolytic parameters’ concentrations among groups under investigation, we defined the main independent predictors among observed 14 parameters to create optimal regression models for assessment of fibrinolytic parameters concentrations. The groups under investigation differ significantly in concentration of tissue plasminogen activator (P<0.001) and inhibitor of plasminogen activator (type 1) (P<0.001). The tissue plasminogen activator concentration correlated significantly with ST depression (r=0.344, P=0.001), T wave variability (r=-0.233, P=0.02), systolic blood pressure (r=-0.675, P<0.001), diastolic blood pressure (r=-0.655, P<0.001), heart rate (r=-0.568, P<0.001) and clinical unstable angina subgroups (r=-0.706, P<0.001) as well as plasminogen activator inhibitor (type 1) concentration associated with age (r=-0.560, P<0.001), body mass index (r=-0.249, P=0.049), ST-segment depression (r=0.542, P<0.001), arrhythmia (r=0.210, P=0.03), systolic blood pressure (r=0.310, P=0.04), and clinical unstable angina subgroups (r=-0.406, P<0.001). An optimal regression models for tissue plasminogen activator and its inhibitor assessment included systolic blood pressure, heart rate, unstable angina subgroup (R2adj. = 65.0%, P<0.001) and systolic blood pressure, unstable angina subgroup (R2adj. = 42.7%, P<0.001), respectively. Thus, fibrinolytic state among unstable angina clinical types differs significantly independently on observed baseline clinical, electrocardiographic and hemodynamic parameters. This finding confirms the utility of Braunwald unstable angina classification.

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Coronary Artery Disease and Endothelial Dysfunction: Novel Diagnostic and Therapeutic Approaches

Cited by 36 publications

References 170 publications

Haracteristics of Myocardial Blood Flow and Coronary Flow Reserve by Pet/Ct in Patients With Coronary Artery Disease With Different Degrees of Coronary Artery Stenosis

Haracteristics of Myocardial Blood Flow and Coronary Flow Reserve by Pet/Ct in Patients With Coronary Artery Disease With Different Degrees of Coronary Artery Stenosis

Lipoprotein-associated phospholipase A2 levels, endothelial dysfunction and arterial stiffness in patients with stable coronary artery disease

Some fibrinolytic parameters in coronary artery disease patients: focus on unstable angina subgroups

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