Coronary Flow Reserve Is Impaired in Young Men With Familial Hypercholesterolemia

Pitkänen, Olli; Raitakari, Olli T.; Niinikoski, Harri; Nuutila, Pirjo; Iida, Hidehiro; Voipio-Pulkki, Liisa Maria; Härkönen, Risto; Wegelius, U; Rönnemaa, Tapani; Viikari, Jorma; Knuuti, Juhani

doi:10.1016/s0735-1097(96)00376-2

Cited by 164 publications

(96 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…When compared to the present study, diabetic patients of our previous study had slightly poorer glycaemic control (HbA 1c 7.4 vs 8.1%) and some of them had also mild background retinopathy which might contribute to the findings. To study the effect of Type I diabetes, the diabetic patients of this study had no diabetic complications or other diseases such as obesity, hypertension and hyperlipidaemia, which are also known to reduce coronary vasoreactivity [5,6,7,8]. In this study we demonstrated that coronary vasoreactivity is already reduced in young patients with uncomplicated Type I diabetes and good glycaemic control.…”

Section: Myocardial Blood Flow During Normoglycaemiamentioning

confidence: 63%

The effects of insulin and short-term hyperglycaemia on myocardial blood flow in young men with uncomplicated Type I diabetes

et al. 2002

View full text Add to dashboard Cite

Aims/hypothesis. Insulin enhances coronary vasodilation in healthy subjects. We tested whether insulin is able to induce coronary vasodilation in Type I (insulin-dependent) diabetic mellitus patients. Additionally, the effect of short-term hyperglycaemia on myocardial perfusion was studied. Methods. Myocardial blood flow was quantitated basally and during adenosine infusion (140 µg/kg per min iv) with or without simultaneous insulin infusion (1 mU/kg per min for 60 min) in nine non-smoking Type I diabetic males (HbA 1c 7.4±1.0%) without diabetic complications and 10 healthy non-diabetic otherwise matched males using positron emission tomography and 15 O-water. Diabetic patients were studied on two occasions, once during normoglycaemia (plasma glucose ~6 mmol/l) and once during hyperglycaemia (~10 mmol/l) induced by reducing the dose of insulin for two days. Results. Resting myocardial blood flow was similar in the studied groups (NS). Hyperaemic adenosine stimulated flow was 23% lower in diabetic than in nondiabetic subjects (3.09±0.72 vs 4.0±1.13 ml·g -1 ·min -1 , p<0.05). Insulin increased significantly adenosine stimulated flow by 23% in diabetic and 17% in nondiabetic subjects (NS between the groups). Hyperglycaemia for two days had no effect on flow values when compared to the values during normoglycaemia (NS). Conclusion/interpretation. Insulin has similar vasodilative effects on coronary arteries in diabetic and nondiabetic subjects. Short-term hyperglycaemia does not alter myocardial blood flow or abolish insulin induced vasodilation in these patients. Insulin induced coronary vasodilation might contribute to the known beneficial effect of intensive insulin therapy on myocardial ischaemia in diabetic patients. [Diabetologia (2002) 45:775-782] Keywords Type I diabetes, myocardial perfusion, coronary vasoreactivity, insulin, hyperglycaemia, positron emission tomography.

show abstract

Section: Myocardial Blood Flow During Normoglycaemiamentioning

confidence: 63%

The effects of insulin and short-term hyperglycaemia on myocardial blood flow in young men with uncomplicated Type I diabetes

et al. 2002

View full text Add to dashboard Cite

show abstract

“…1 It has been shown that MVD can be altered without evidence of ischemia in hypercholesterolemics [2][3][4] and that there is a significant inverse relationship between MVD and plasma TG levels in hyperlipidemics without evidence of ischemia. 3,5 In fact, alterations in MVD without overt coronary stenosis have been indicated in a variety of conditions; for example, hypertrophic cardiomyopathy, 6 dilated cardiomyopathy, 7 and diabetes with and without associated hypertension, 8 -10 and in normal segments in patients with myocardial infarction.…”

mentioning

confidence: 99%

Altered Myocardial Vasodilatation in Patients With Hypertriglyceridemia in Anatomically Normal Coronary Arteries

Yokoyama

Ohtake

Momomura

et al. 1998

ATVB

View full text Add to dashboard Cite

Abstract-Reduced myocardial vasodilatation (MVD) in hypercholesterolemics without overt coronary stenosis has been reported.However, the status of MVD in hypertriglyceridemics has not yet been clarified. The aim of this study was to investigate whether MVD is impaired in patients with hypertriglyceridemia without overt coronary stenosis. Twenty-three hypertriglyceridemics (10 normocholesterolemic hypertriglyceridemics [HTGs] and 13 mixed combined hyperlipidemics [MCHLs]) and 13 age-matched controls were studied. All patients were proven to have more than one normal coronary artery, as diagnosed by coronary angiography, and those segments that were perfused by anatomically normal coronary arteries were used in the study. Myocardial blood flow (MBF) during dipyridamole (DP) loading and baseline MBF were measured by using positron emission tomography and [13 N]ammonia, after which MVD was calculated. Baseline MBF (mL ⅐ min Ϫ1 ⅐ 100 g Ϫ1) was comparable among HTG (76.0Ϯ26.1), MCHL (77.0Ϯ26.1), and controls (80.3Ϯ38.5). However, MBF during DP loading was significantly lower in MCHL (159Ϯ52.5) than in control subjects (292Ϯ166, PϽ.01), while it was comparable in HTG (202Ϯ104) and controls. MVD was significantly reduced in both HTG (2.70Ϯ1.09, PϽ.05) and MCHL (2.07Ϯ.70, PϽ.01) compared with controls (3.73Ϯ1.14). MVD in MCHLs tended to be reduced compared with that in HTGs, but the difference was statistically insignificant (Pϭ.08). There was a significant relationship between MVD and both plasma triglycerides (rϭϪ.47, PϽ.01) and plasma total cholesterol (rϭϪ.55, PϽ.01). When controls and HTGs were combined, the relationship between MVD and plasma total triglycerides became more prominent (rϭϪ.55, PϽ.05), and the significant relationship between cholesterol level and MVD disappeared. Multivariate regression analysis has revealed that the triglyceride level (Fϭ5.2, PϽ.05) was independently related to MVD (rϭ.69, PϽ.01). In conclusion, MVD was reduced in hypertriglyceridemics in anatomically normal coronary arteries. Hypertriglyceridemia is an independent factor for this abnormality. (Arterioscler Thromb Vasc Biol. 1998;18:294-299.) Key Words: hyperlipidemia Ⅲ hypertriglyceridemia Ⅲ atherosclerosis Ⅲ myocardial vasodilatation Ⅲ PET R educed MVD has been thought to be a factor in coronary stenosis.1 It has been shown that MVD can be altered without evidence of ischemia in hypercholesterolemics 2-4 and that there is a significant inverse relationship between MVD and plasma TG levels in hyperlipidemics without evidence of ischemia. 3,5 In fact, alterations in MVD without overt coronary stenosis have been indicated in a variety of conditions; for example, hypertrophic cardiomyopathy, 6 dilated cardiomyopathy, 7 and diabetes with and without associated hypertension, 8 -10 and in normal segments in patients with myocardial infarction. 11 We have reported a reduced MVD without overt coronary stenosis in patients with hypercholesterolemia. 12However, most recent studies, including our own, involved patients with pure hyperchole...

show abstract

“…Yokoyama, et al reported that coronary flow reserve in hypercholesterolemic patients is decreased even in an anatomically normal coronary artery territory, 11) and impaired coronary flow reserve has been demonstrated in asymptomatic subjects with familial hypercholesterolemia. 12,13) Similarly, previous studies showed that coronary flow reserve in diabetic patients was reduced without angiographic coronary stenosis. [14][15][16] Several diagnostic approaches, invasively by Doppler flow [17][18][19][20] and pressure wire, 21) or noninvasively by positron emission computed tomography, 22,23) have been introduced for the evaluation of coronary vasodilator reserve, defined as the ratio of maximal to basal coronary flow.…”

mentioning

confidence: 75%

Impaired Exercise-Related Myocardial Uptake of Technetium-99m-Tetrofosmin in Relation to Coronary Narrowing and Diabetic State. Assessment with Quantitative Single Photon Emission Computed Tomography.

et al. 2001

View full text Add to dashboard Cite

SUMMARYDespite the diagnostic efficacy of stress myocardial perfusion imaging, the correlation between the actual perfusion tracer activity and diseased state of a coronary artery has not been studied in detail. We estimated exercise-related perfusion augmentation in relation to disease states of a coronary artery in diabetic and non-diabetic patients by a newly developed quantitative technetium (Tc)-99m-tetrofosmin myocardial imaging technique. Tc-99m-tetrofosmin tomographic imaging with an exercise-rest protocol was performed in 26 stable coronary patients and in 8 age-matched controls. Percent increase (%IR) in myocardial count during symptom-limited submaximal exercise-stress was calculated in 16 non-infarcted polar map segments and in each coronary territory by a subtraction technique with corrections for physical decay and injected tracer doses, and the results were compared with those of angiographically quantified coronary diameter stenosis (%DS). Percent IR and peak heart rate during exercise showed a positive linear correlation both in coronary territories with significant stenosis (%DS ≥ 75%) and in control or nonstenotic (%DS < 75%) territories. The regression line in stenotic regions was, however, significantly (p < 0.01) shifted downward compared to that in non-stenotic regions. Percent IR in stenotic regions showed a significant inverse correlation with %DS. Coronary stenosis of 75% or more was identified by a %IR cutoff value of 40% with 77% sensitivity, 70% specificity, and an accuracy of 72%. In coronary territories with a %DS of less than 75%, %IR in diabetic patients was significantly lower (46 ± 15%) than that in nondiabetic patients (61 ± 25%). Thus, blunted exercise-related augmentation of myocardial uptake of Tc-99m-tetrofosmin correlates with the severity of coronary narrowing and diabetic state. (Jpn Heart J 2001; 42: 29-42)

show abstract

Coronary Flow Reserve Is Impaired in Young Men With Familial Hypercholesterolemia

Abstract: Coronary flow reserve is reduced in young men with FH, and, consequently, coronary resistance during hyperemia is increased. The results demonstrate very early impairment of coronary vasomotion in hypercholesterolemic patients.

Cited by 164 publications

References 25 publications

The effects of insulin and short-term hyperglycaemia on myocardial blood flow in young men with uncomplicated Type I diabetes

The effects of insulin and short-term hyperglycaemia on myocardial blood flow in young men with uncomplicated Type I diabetes

Altered Myocardial Vasodilatation in Patients With Hypertriglyceridemia in Anatomically Normal Coronary Arteries

Impaired Exercise-Related Myocardial Uptake of Technetium-99m-Tetrofosmin in Relation to Coronary Narrowing and Diabetic State. Assessment with Quantitative Single Photon Emission Computed Tomography.

Contact Info

Product

Resources

About