Impaired coronary flow reserve evaluated by echocardiography is associated with increased aortic stiffness in patients with metabolic syndrome: an observational study

Tok, Derya; Özcan, Fırat; Kadife, İskender; Turak, Osman; Cagli, Kumral; Başar, Nurcan; Gölbaşı, Zehra; Aydoğdu, Sinan

doi:10.5152/akd.2013.068

Cited by 5 publications

(3 citation statements)

References 50 publications

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“… 5 - 7 , 11 , 18 - 22 EFT is increased in patients with inflammation, advanced age, obesity, hypercholesterolemia, hypertension, atrial fibrillation, diabetes mellitus and metabolic syndrome. 3 , 4 , 10 , 23 - 27 In our study, there was no significant difference between the groups in terms of blood glucose and body mass index. The number of patients diagnosed with metabolic syndrome, diabetes and hypertension was similar between groups ( Table 1 ).…”

Section: Discussioncontrasting

confidence: 47%

The Relationship between GRACE Score and Epicardial Fat Thickness in non-STEMI Patients

Gül¹,

Zungur²,

Aykan³

et al. 2016

Arquivos Brasileiros De Cardiologia

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BackgroundGRACE risk score (GS) is a scoring system which has a prognostic significance in patients with non-ST segment elevation myocardial infarction (non-STEMI).ObjectiveThe present study aimed to determine whether end-systolic or end-diastolic epicardial fat thickness (EFT) is more closely associated with high-risk non-STEMI patients according to the GS.MethodsWe evaluated 207 patients who had non-STEMI beginning from October 2012 to February 2013, and 162 of them were included in the study (115 males, mean age: 66.6 ± 12.8 years). End-systolic and end-diastolic EFTs were measured with echocardiographic methods. Patients with high in-hospital GS were categorized as the H-GS group (in hospital GS > 140), while other patients were categorized as the low-to-moderate risk group (LM-GS).ResultsSystolic and diastolic blood pressures of H-GS patients were lower than those of LM-GS patients, and the average heart rate was higher in this group. End-systolic EFT and end-diastolic EFT were significantly higher in the H-GS group. The echocardiographic assessment of right and left ventricles showed significantly decreased ejection fraction in both ventricles in the H-GS group. The highest correlation was found between GS and end-diastolic EFT (r = 0.438).ConclusionEnd-systolic and end-diastolic EFTs were found to be increased in the H-GS group. However, end-diastolic EFT and GS had better correlation than end-systolic EFT and GS.

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Section: Discussioncontrasting

confidence: 47%

The Relationship between GRACE Score and Epicardial Fat Thickness in non-STEMI Patients

Gül¹,

Zungur²,

Aykan³

et al. 2016

Arquivos Brasileiros De Cardiologia

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“…Similarly, microvascular dysfunction of the coronary arterioles as evaluated using abnormal transthoracic Doppler echocardiography after intravenous infusion of the adenosine uptake inhibitor dipyridamole was described in a cohort of patients with MS (i.e., increased levels of LDL and triglycerides but reduced levels of HDL cholesterol)(Pirat et al, 2008). In a cohort of forty-five MS patients, a reduced coronary flow reserve after infusion of adenosine was also determined by echocardiography, which was correlated with body mass index, waist circumference, fasting glucose levels, more sensitive C-reactive protein and the HDL and triglycerides levels(Tok et al, 2013). Another study with fourteen dyslipidaemic patients showed that after intravenous adenosine infusion, the myocardial blood flow and endothelial-dependent vasodilation of coronary vessels was reduced in those subjects as measured by PET(Alexanderson et al, 2010).…”

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confidence: 99%

Adenosine receptors: Modulators of lipid availability that are controlled by lipid levels

Leiva

Guzmán-Gutiérrez

Contreras-Duarte

et al. 2017

Molecular Aspects of Medicine

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Adenosine as well as agonists and antagonists for the four adenosine receptor subtypes (A1R, A2AR, A2BR and A3R) play a role in several key physiological and pathophysiological processes, including the regulation of vascular tone, thrombosis, immune response, inflammation, and angiogenesis. This review focuses on the adenosine-mediated regulation of lipid availability in the cell and in the systemic circulation as well in humans and animal models. Therefore, adenosine, mainly by acting on A1R, inhibits lipolysis activity, leading to reduction of the circulating fatty acid levels. This nucleoside can also participate in the early development of atherosclerosis by inhibiting the formation of foam cells via stimulation of cholesterol efflux through A2AR expressed on macrophages and reduction of the inflammatory process by activating A2AR and A2BR. Adenosine also appears to modulate intracellular cholesterol availability in Niemann-Pick type C1 disease and Alzheimer disease via A2AR and A3, respectively. Remarkably, the role of adenosine receptors in the regulation of plasma total cholesterol and triglyceride levels has been studied in animal models. Thus, an anti-atherogenic role for A2BR as well as a pro-atherogenic role of A2AR and A1 have been proposed; A3R has not been shown to participate in the control of lipid levels or the development of atherosclerosis. Surprisingly, and despite the role of A2A in the inhibition of foam cell formation among isolated cells, this receptor appears to be pro-atherogenic in mice. Remarkably, the role of adenosine receptors in human dyslipidaemia and atherosclerosis must to be elucidated. Additionally, it has been reported that increased lipid levels impair the effects of adenosine/adenosine receptors in controlling vascular tone, and we speculate on the possibility that this impairment could be due to alterations in the composition of the membrane microdomains where the adenosine receptors are located. Finally, a possible role for adenosine/adenosine receptors in the phenomena of dyslipidaemia in pregnancy has been proposed.

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“…In this study, the evaluation of aortic stiffness was performed via relating change in diameter of aorta to distending pressure, not assessed by pulse wave velocity (PWV) (15). In previous studies, significant correlations between CFR and aortic stiffness assessed by PWV have been demonstrated in patients with hypertension and coronary artery disease.…”

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confidence: 99%

Relations between microvascular function and aortic stiffness in metabolic syndrome

Joon¹,

Cho²

2013

Anadolu Kardiyol Derg

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The metabolic syndrome (MetS) is characterized by abdominal obesity, elevated blood pressure, hypertriglycemia, low highdensity lipoprotein (HDL) cholesterolemia, and hyperglyceridmia (1). Vascular dysfunction caused by endothelial dysfunction is an early abnormality in the MetS that may contribute to premature atherosclerosis (2). Each of the components of the MetS has been independently associated with vascular dysfunction (3-5). Because there was the 2.6-fold increased risk of coronary death among those with the MetS (6), other mechanisms may contribute to the potential adverse effect of features of the MetS on vascular function and, in particular, endothelial function, thereby increasing the potential for atherothrombotic complications (7). Several studies demonstrated the relationship between MS and coronary microvascular circulation. MetS patients showed impaired response of myocardial blood flow to a cold press or test in by PET analysis (8), indicating the presence of coronary microvascular endothelial dysfunction. Similarly, MetS patients showed an impaired coronary blood flow in with angiographically normal coronary arteries by Thrombolysis in Myocardial Infarction frame count method (9). Moreover, patients with MetS showed an impaired vasodilatory response to pharmacologic agents in the left ascending of coronary artery by transthoracic echocardiography (10). Possible mechanisms for impaired coronary vasodilation in patients with MetS are insulin resistance which may induce endothelial dysfunction mediated by oxidative stress (11), reduced adiponectin which have a role in the phosphorylation of eNOS (12), release of proinflammatory cytokines (e.g., interleukin-6, tumor necrosis factor-α) by visceral adipose tissue (13). These mechanisms may solely and/or multifactorially contribute to coronary endothelial dysfunction in MetS patients (14).The present study revealed that coronary flow reserve (CFR) is impaired in patients with MetS and there is an independent relationship between impaired CFR and increased aortic stiffness evaluated by echocardiography. This study demonstrates that CFR was significantly correlated with age, blood pressure, waist circumference, lipid profile, fasting glucose, high-sensitivity C-reactive protein, left ventricular (LV) mass index , and aortic stiffness. The relationship between CFR and aortic stiffness persisted after adjusting for age and each components of MetS.In this study, the evaluation of aortic stiffness was performed via relating change in diameter of aorta to distending pressure, not assessed by pulse wave velocity (PWV) (15). In previous studies, significant correlations between CFR and aortic stiffness assessed by PWV have been demonstrated in patients with hypertension and coronary artery disease. PWV is the gold standard of aortic stiffness and easily performed in clinical practice. To prove the efficacy of newly non-invasive method to detect the aortic stiffness, the description of the method is needed, but the authors did not describe the methodological re...

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Impaired coronary flow reserve evaluated by echocardiography is associated with increased aortic stiffness in patients with metabolic syndrome: an observational study

Cited by 5 publications

References 50 publications

The Relationship between GRACE Score and Epicardial Fat Thickness in non-STEMI Patients

The Relationship between GRACE Score and Epicardial Fat Thickness in non-STEMI Patients

Adenosine receptors: Modulators of lipid availability that are controlled by lipid levels

Relations between microvascular function and aortic stiffness in metabolic syndrome

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