Early impairment of coronary flow reserve in young men with borderline hypertension

Laine, Hanna; Raitakari, Olli T.; Niinikoski, Harri; Pitkänen, Olli; Iida, Hidehiro; Viikari, Jorma; Nuutila, Pirjo; Knuuti, Juhani

doi:10.1016/s0735-1097(98)00222-8

Cited by 192 publications

(114 citation statements)

References 40 publications

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“…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

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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.

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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

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“…During the scan period, three blood samples were drawn at 2-min intervals and blood radioactivity was measured immediately with a well counter (Bicron 3MW3/3, USA Calculation of regional myocardial blood flow and coronary vascular resistance Regions of interest (ROIs) were drawn in the lateral and anterior wall of the left ventricle in four representative transaxial slices in each study, as previously described. 29 The ROIs outlined in the baseline images were copied to the images obtained after adenosine administration. Values of regional myocardial blood flow (expressed in ml/g of tissue per minute) were calculated according to the previously published method using the single-compartment model.…”

Section: Image Acquisition Processing and Correctionsmentioning

confidence: 99%

Short-term changes in inflammatory response protein (hsCRP) do not parallel with changes in coronary vasoreactivity in obese men

et al. 2005

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Aim: Obese subjects are characterized by increased high-sensitivity C-reactive protein (hsCRP) and coronary vascular resistance. Clucocorticoids suppress inflammation, a possible cardioprotective effect. We tested the short-term anti-inflammatory effect of dexamethasone (dx) on these parameters in obese subjects. Methods: Coronary vascular resistance was quantitated basally and during adenosine infusion with or without simultaneous euglycemic hyperinsulinemic clamp (insulin infusion rate of 1 mU/kg/min) in 11 obese and 19 age-matched nonobese males using positron emission tomography and 15 O-water. Each subject was studied both with and without previous dx treatment for 2 days (2 mg/day). Results: Before dx treatment, hsCRP concentration was significantly higher in obese than in nonobese subjects (1.5571.73 vs 0.3270.32 mg/l, P ¼ 0.005). In addition, coronary vascular resistances were higher (Po0.05) in obese than in nonobese subjects at baseline (139736 vs 117722) and during adenosine infusion without (3277 vs 2677) or with simultaneous clamp (2678 vs 2175 mmHg min g/ ml). Dx treatment decreased significantly hsCRP concentration in obese but not in nonobese subjects, leading to similar hsCRP concentrations between the groups (0.4570.43 vs 0.2670.42 mg/l, respectively, P ¼ 0.3). Dx had no effect on coronary vascular resistances (NS). Conclusions: Obese subjects are characterized by high hsCRP, which can be normalized by dx. However, despite this, coronary vascular resistances did not decrease in obese subjects. Short-term changes in inflammatory response protein appear not to parallel with changes in coronary vasoreactivity in obese men.

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“…In particular, in hypertensives' heart disease, the pressure-volume overload means a burden to the ventricle as well as to the coronary vessels, which has several potential consequences for the coronary microcirculation: (a) resistance vessels, capillaries, perivascular interstitium, and myocytes are liable to suffer damage by hypoperfusion; (b) arterial vascular walls are under increased shear and wall stress (dysfunctional endothelial function with inadequate nitric oxide production), 32 (c) hypertrophy of the myocytes leads to an increase in the distance between parallel oriented arterioles and capillaries (relative rarefaction). 5,6 In addition, several other extravascular mechanisms can contribute to the impairment of coronary vasodilator reserve in hypertensives; these include: the negative effect of impaired diastolic relaxation on coronary filling, the compression of the coronary circulation by high left ventricular filling pressure and relative increased force of contraction. An impairment of the arteriolar vasodilatation response to dipyridamole/adenosine was observed in hypertensive patient.…”

Section: Coronary Microcirculation In Pathological and Physiological Lvhmentioning

confidence: 99%

“…4 There are some observations, that suggest that the coronary microcirculatory function is altered in pathological LVH also in the absence of an associated coronary artery disease (CAD), reflecting a reduction in the density of resistance coronary arterioles, an increase in their wall thickness/ lumen ratio, a reduction in the coronary vasodilator capacity, and an increase in the systolic difficulty of coronary flow in LVH. 5 Different methodological approaches such as nuclear PET 6,7 and intravascular ultrasound have been used to study this problem. 8,9 The aim of the present study of myocardial perfusion by quantitative myocardial contrast echocardiography (QMCE), 10,11 was to analyse some functional coronary microcirculatory aspects (CM) both at rest and after vasodilator stimulus (dipyridamole) in two different models of LVH in humans: physiological (athlete's heart) and pathological (hypertensive heart).…”

Section: Introductionmentioning

confidence: 99%

Coronary microcirculation into different models of left ventricular hypertrophy—hypertensive and athlete's heart: a contrast echocardiographic study

et al. 2003

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Early impairment of coronary flow reserve in young men with borderline hypertension

Cited by 192 publications

References 40 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

Short-term changes in inflammatory response protein (hsCRP) do not parallel with changes in coronary vasoreactivity in obese men

Coronary microcirculation into different models of left ventricular hypertrophy—hypertensive and athlete's heart: a contrast echocardiographic study

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