The effect of acute administration of statins on coronary microcirculation during the pre-revascularization period in patients with myocardial infraction

Paraskevaidis, Ioannis; Iliodromitis, Efstathios K.; Ikonomidis, Ignatios; Rallidis, Lοukianos S.; Hamodraka, E.; Parissis, John; Andoniadis, Aias; Tzortzis, Stavros; Anastasiou-Nana, Maria

doi:10.1016/j.atherosclerosis.2012.04.002

Cited by 14 publications

(11 citation statements)

References 36 publications

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“…To the extent that these associations are confirmed as causal, the implications for treatment and prevention will be substantial. Much of the benefit of statins and angiotensin converting enzyme inhibitors may relate to previously under-considered targets in the microcirculation 53, 54 . Future clinical trials to evaluate therapies designed to improve microvascular function, may also provide benefit for conduit artery disease and for cardiomyopathies associated with arteriolar dysfunction.…”

Section: The Microcirculation As a Window Into Conduit Artery Diseasementioning

confidence: 99%

The Human Microcirculation

Gutterman

Chabowski

Kadlec

et al. 2016

Circulation Research

234

141

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The microcirculation is responsible for orchestrating adjustments in vascular tone to match local tissue perfusion with oxygen demand. Beyond this metabolic dilation, the microvasculature plays a critical role in modulating vascular tone by endothelial release of an unusually diverse family of compounds including nitric oxide, other reactive oxygen species, and arachidonic acid metabolites. Animal models have provided excellent insight into mechanisms of vasoregulation in health and disease. However there are unique aspects of the human microcirculation that serve as the focus of this review. The concept is put forth that vasculo-parenchymal communication is multimodal, with vascular release of nitric oxide eliciting dilation and preserving normal parenchymal function by inhibiting inflammation and proliferation. Likewise, in disease or stress, endothelial release of ROS both mediates dilation and parenchymal inflammation leading to cellular dysfunction, thrombosis, and fibrosis. Some pathways responsible for this stress-induced shift in mediator of vasodilation are proposed. This paradigm may help explain why microvascular dysfunction is such a powerful predictor of cardiovascular events, and help identify new approaches to treatment and prevention.

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Section: The Microcirculation As a Window Into Conduit Artery Diseasementioning

confidence: 99%

The Human Microcirculation

Gutterman

Chabowski

Kadlec

et al. 2016

Circulation Research

234

141

View full text Add to dashboard Cite

show abstract

“…Accordingly, it has been hypothesized that the action of statins to reduce the accumulation and inflammation of epicardial adipose tissue might not only have a salutary effect on nearby coronary vessels, but also on the underlying ventricular myocardium. Such an action could explain why, in experimental models, statins ameliorate microcirculatory derangements, cardiac fibrosis and their associated echocardiographic ventricular filling abnormalities . As a result of these effects, the anti‐inflammatory action of statins might be useful (particularly in people with metabolic disorder) by acting primarily to prevent the development of HFpEF, rather than heart failure with a reduced ejection fraction (HFrEF) .…”

Section: Differential Effects Of Statins In Preserved Vs Reduced Ejementioning

confidence: 99%

Are the effects of drugs to prevent and to treat heart failure always concordant? The statin paradox and its implications for understanding the actions of antidiabetic medications

Packer

2018

European J of Heart Fail

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Most treatments for chronic heart failure are effective both in preventing its onset and reducing its progression. However, statins prevent the development of heart failure, but they do not decrease morbidity and mortality in those with established heart failure. This apparent discordance cannot be explained by an effect to prevent interval myocardial infarctions. Instead, it seems that the disease that statins were preventing in trials of patients with a metabolic disorder was different from the disease that they were treating in trials of chronic heart failure. The most common phenotype of heart failure in patients with obesity and diabetes is heart failure with a preserved ejection fraction (HFpEF). In this disorder, the anti-inflammatory effects of statins might ameliorate myocardial fibrosis and cardiac filling abnormalities, but these actions may have little relevance to patients with heart failure and a reduced ejection fraction (HFrEF), whose primary derangement is cardiomyocyte loss and stretch. These distinctions may explain why statins were ineffective in trials that focused on HFrEF, but have been reported to produce favourable effects in observational studies of HFpEF. Similarly, selective cytokine antagonists were ineffective in HFrEF, but have been associated with benefits in HFpEF. These observations may have important implications for our understanding of the effects of antihyperglycaemic medications. Glucagon-like peptide-1 receptor agonists have had neutral effects on heart failure events in people at risk for HFpEF, but have exerted deleterious actions in HFrEF. Similarly, sodium-glucose co-transporter 2 inhibitors, which exert anti-inflammatory effects and reduce heart failure events in patients who are prone to HFpEF, may not be effective in HFrEF. The distinctions between HFrEF and HFpEF may explain why the effects of drugs on heart failure events in diabetes trials may not be relevant to their use in patients with systolic dysfunction.

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“…Nowadays, RT-MCE is conventionally used in clinical practice to detect significant angiographic CAD and to assess myocardial viability ( 12 , 13 ). The parameters calculated from RT-MCE are useful in assessing CM dysfunction with indices, such as A for myocardial blood flow volume (MBV), β for myocardial blood flow (MBF) velocity, and A×β for mean MBF ( 14 , 15 ). Our study aimed to use RT-MCE to evaluate CM function in CAD patients.…”

Section: Introductionmentioning

confidence: 99%

The value of real-time myocardial contrast echocardiography for detecting coronary microcirculation function in coronary artery disease patients

Sun¹,

Wang²,

Xu³

et al. 2018

Anatol J Cardiol

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Objective:The aim of this study was to evaluate the value of real-time myocardial contrast echocardiography (RT-MCE) for detecting coronary microcirculation (CM) function in coronary artery disease (CAD) patients.Methods:Sixty-five consecutive patients were divided into CAD (n=52) and no-CAD (n=13) groups using coronary angiography (CAG). All patients underwent RT-MCE at rest and CAG within 1 week after RT-MCE. The ventricular segments in CAD patients were divided semi-quantitatively into ischemic and non-ischemic myocardial groups based on RT-MCE images. Myocardial blood volume (A), myocardial blood flow velocity (β), and mean myocardial blood flow (A×β) were obtained. The Gensini scores were calculated for CAD patients. The receiver operating characteristic (ROC) curve areas of A, β, and A×β were calculated to assess CM function in CAD patients.Results:A total of 798 and 204 segments were investigated in the CAD and non-CAD groups, respectively. In CAD patients, 332 ischemic and 466 non-ischemic segments were identified. The values of A, β, and A×β were significantly different among non-CAD, CAD, ischemic, and non-ischemic groups. ROC curve areas of A, β, and A×β were 0.85, 0.79, and 0.83, respectively, and significant differences were observed in these values among three Gensini score groups of the CAD patients.Conclusion:Varying degrees of CM function deterioration was observed in CAD patients both in ischemic and non-ischemic areas, with the deterioration being more sever in the former.

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The effect of acute administration of statins on coronary microcirculation during the pre-revascularization period in patients with myocardial infraction

Cited by 14 publications

References 36 publications

The Human Microcirculation

The Human Microcirculation

Are the effects of drugs to prevent and to treat heart failure always concordant? The statin paradox and its implications for understanding the actions of antidiabetic medications

The value of real-time myocardial contrast echocardiography for detecting coronary microcirculation function in coronary artery disease patients

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