Early detection of left ventricular dysfunction in first-degree relatives of diabetic patients by myocardial deformation imaging: The role of endothelial glycocalyx damage

Ikonomidis, Ignatios; Pavlidis, George; Lambadiari, Vaia; Kousathana, F; Varoudi, Maria; Spanoudi, Filio; Maratou, Eirini; Parissis, John; Triantafyllidi, Helen; Dimitriadis, George; Lekakis, John

doi:10.1016/j.ijcard.2017.01.056

Cited by 34 publications

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References 32 publications

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“…Sublingual areas either on the left or right side of the frenulum gave identical results in repeated estimations . The applications of the method to various clinical studies have been extensively validated in a number of recent publications …”

Section: Methodsmentioning

confidence: 87%

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Increase in perfused boundary region of endothelial glycocalyx is associated with higher prevalence of ischemic heart disease and lesions of microcirculation and vascular wall

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Section: Methodsmentioning

confidence: 87%

“…12 The applications of the method to various clinical studies have been extensively validated in a number of recent publications. [13][14][15][16]…”

Section: Perfusion Of Sublingual Endothelial Glycocalyxmentioning

confidence: 99%

Increase in perfused boundary region of endothelial glycocalyx is associated with higher prevalence of ischemic heart disease and lesions of microcirculation and vascular wall

et al. 2018

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“…The integrity of endothelial glycocalyx plays a vital role in vascular permeability, inflammation, and elasticity and is also linked with the pathophysiological pathways of atherosclerosis . Loss of endothelial glycocalyx intergrity has been shown to occur during exposure to atherogenic risk factors including hypeglycemia, hyperlidemia and smoking . Studies have shown that endothelial glycocalyx serves as an effective buffer barrier for sodium .…”

Section: Introductionmentioning

confidence: 99%

“…8,9 Loss of endothelial glycocalyx intergrity has been shown to occur during exposure to atherogenic risk factors including hypeglycemia, hyperlidemia and smoking. [10][11][12][13][14][15] Studies have shown that endothelial glycocalyx serves as an effective buffer barrier for sodium. 16 Damaged endothelial glycocalyx facilitates sodium entry into the endothelial cells and thus, endothelial glycocalyx damage has been proposed as the mechanism mediating the association between endothelial dysfunction and arterial hypertension observed in sodium abuse in experimental studies.…”

Section: Introductionmentioning

confidence: 99%

Association of impaired endothelial glycocalyx with arterial stiffness, coronary microcirculatory dysfunction, and abnormal myocardial deformation in untreated hypertensives

Ikonomidis

Voumvourakis

Makavos

et al. 2018

J of Clinical Hypertension

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We investigated the association of endothelial glycocalyx damage with arterial stiffness, impairment of coronary microcirculatory function, and LV myocardial deformation in 320 untreated hypertensives and 160 controls. We measured perfused boundary region (PBR) of the sublingual microvessels, a marker inversely related with glycocalyx thickness, coronary flow reserve (CFR), and Global Longitudinal strain (GLS) by echocardiography, pulse wave velocity (PWV), and central systolic blood pressure (cSBP). Hypertensives had higher PBR, PWV cSBP, and lower CFR and GLS than controls (P < .05). In hypertensives, increased PBR was associated with increased cSBP, PWV, and decreased CFR and GLS after adjustment for age, sex, BMI, smoking LV mass, heart rate, hyperlipidemia, and office SBP (P < .05). PBR had an additive value to PWV, CFR, and office SBP for the prediction of abnormal GLS (x 2 = 2.4-3.8, P for change = .03). Endothelial glycocalyx is impaired in untreated hypertensives and is related to arterial stiffness, coronary, and myocardial dysfunction. | 673IKONOMIDIS et al.reserve (CFR), a marker of coronary microcirculatory function, is related to arterial stiffness and is impaired in hypertensive heart disease. 22 The effect of endothelial glycocalyx damage on arterial wall properties, coronary flow reserve, and LV myocardial deformation has not been clarified.We hypothesized that endothelial glycocalyx is impaired in newly diagnosed untreated hypertensives, leading to impaired arterial elasticity, coronary flow reserve, and consequently, abnormal myocardial deformation. Therefore, we investigated the association of endothelial glycocalyx damage with pulse wave velocity, coronary flow reserve, and LV myocardial deformation in untreated hypertensives. | MATERIAL S AND ME THODS | Study populationOut of 348 consecutive patients with new onset essential hypertension who attended our outpatient hypertension clinic, 320 patients (mean age: 51 ± 11 years, 67% males) with normal ejection fraction (>60%) had adequate 2-dimensional echocardiography images for the analysis of speckle parameters (feasibility of the method 92%). The diagnosis of essential hypertension was defined as One-hundred and sixty normotensive individuals (age:48 ± 13 years, 66% males) who visited our outpatient clinic for a routine check-up were selected using a ratio of 1 control to 2 hypertensive patients as controls.Exclusion criteria were history of diabetes, familiar hyperlipidemia, coronary artery disease (CAD), cardiomyopathy, and chronic pulmonary disease. All patients and controls had no history of CAD, normal resting electrocardiogram, and underwent a non-invasive test (thallium scintigraphy after a treadmill exercise test or dobutamine stress echocardiography) to exclude myocardial ischemia. None of the female patients were on hormone replacement treatment. None of the patients or controls were on any kind of medication, including statins. All patients and controls had a glomerular filtration rate (GFR) > 60 mL/min/1.732 (MDRD formula) at enr...

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“…We measured the PBR of the sublingual arterial microvessels (with diameter ranging from 5 to 9 μm) using Sidestream Darkfield imaging (Microscan, Glycocheck, Microvascular Health Solutions Inc., Salt Lake City, UT, USA). [12][13][14] Sidestream Darkfield imaging provides a direct, non-invasive, operator independent, easy to perform, and fast method (duration of ~3 minute) for the assessment of the EG. It has standardized methodology, it provides multiple measurements of sample sites (>3000 vascular segments of sublingual microvasculature) and estimation of the EG integrity of the microvessels ranging from 5 to 25 μm in diameter, and it has a very good reproducibility 14 and thus is proposed as a valid method to assess endothelial integrity by the European Society of Cardiology Working Group on Peripheral Circulation.…”

Section: Endothelial Glycocalyxmentioning

confidence: 99%

HDL cholesterol levels and endothelial glycocalyx integrity in treated hypertensive patients

Triantafyllidi

Benas

Vlachos

et al. 2018

J of Clinical Hypertension

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Endothelial dysfunction indicates target organ damage in hypertensive patients. The integrity of endothelial glycocalyx (EG) plays a vital role in vascular permeability, inflammation and elasticity, and finally to cardiovascular disease. The authors aimed to investigate the role of increased HDL cholesterol (HDL‐C) levels, which usually are considered protective against cardiovascular disease, in EG integrity in older hypertensive patients. The authors studied 120 treated hypertensive patients older than 50 years were divided regarding HDL‐C tertiles in group HDLH (HDL‐C ≥ 71 mg/dL, upper HDL‐C tertile) and group HDLL (HDL‐C < 71 mg/dL, two lower HDL‐C tertiles). Increased perfusion boundary region (PBR) of the sublingual arterial microvessels (ranging from 5 to 9 µm) using Sideview Darkfield imaging (Microscan, Glycocheck) was measured as a non‐invasive accurate index of reduced EG thickness. PBR 5‐9 was significantly decreased in group HDLH (P = 0.04). In the whole population, HDL‐C was inversely but moderately related to PBR 5‐9 (r = −0.22, P = 0.01). In a multiple linear regression analysis model, using age, BMI, smoking habit, HDL‐C, LDL‐C, and office SBP, as independent variables, the authors found that BMI (β = 0.25, P = 0.006) independently predicted PBR 5‐9 in the whole population. In older hypertensive patients, HDL‐C ranging between 71 and 101 mg/dL might moderately protect EG and subsequently endothelial function. Future studies in several groups of low‐ or high‐risk hypertensives are needed in order to evaluate the beneficial role of extremely elevated HDL‐C regarding cardiovascular risk evaluation as well as endothelial glycocalyx as a novel index of target organ damage in essential hypertension.

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Early detection of left ventricular dysfunction in first-degree relatives of diabetic patients by myocardial deformation imaging: The role of endothelial glycocalyx damage

Cited by 34 publications

References 32 publications

Increase in perfused boundary region of endothelial glycocalyx is associated with higher prevalence of ischemic heart disease and lesions of microcirculation and vascular wall

Increase in perfused boundary region of endothelial glycocalyx is associated with higher prevalence of ischemic heart disease and lesions of microcirculation and vascular wall

Association of impaired endothelial glycocalyx with arterial stiffness, coronary microcirculatory dysfunction, and abnormal myocardial deformation in untreated hypertensives

HDL cholesterol levels and endothelial glycocalyx integrity in treated hypertensive patients

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