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Chakrala T, Prakash R, Valdes C, Pepine CJ, Keeley EC. Circulating Biomarkers in Coronary Microvascular Dysfunction. J Am Heart Assoc 2023:e029341. [PMID: 37301749 DOI: 10.1161/jaha.122.029341] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Coronary microvascular dysfunction is an underdiagnosed pathologic process that is associated with adverse clinical outcomes. Biomarkers, molecules measurable in the blood, could inform the clinician by aiding in the diagnosis and management of coronary microvascular dysfunction. We present an updated review of circulating biomarkers in coronary microvascular dysfunction representing key pathologic processes, including inflammation, endothelial dysfunction, oxidative stress, coagulation, and other mechanisms.
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Affiliation(s)
- Teja Chakrala
- Department of Medicine University of Florida Gainesville FL USA
| | - Roshni Prakash
- Department of Medicine University of Florida Gainesville FL USA
| | - Carlos Valdes
- Department of Medicine University of Florida Gainesville FL USA
| | - Carl J Pepine
- Department of Medicine University of Florida Gainesville FL USA
- Division of Cardiovascular Medicine University of Florida Gainesville FL USA
| | - Ellen C Keeley
- Department of Medicine University of Florida Gainesville FL USA
- Division of Cardiovascular Medicine University of Florida Gainesville FL USA
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Phadwal K, Koo E, Jones RA, Forsythe RO, Tang K, Tang Q, Corcoran BM, Caporali A, MacRae VE. Metformin protects against vascular calcification through the selective degradation of Runx2 by the p62 autophagy receptor. J Cell Physiol 2022; 237:4303-4316. [PMID: 36166694 DOI: 10.1002/jcp.30887] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 11/09/2022]
Abstract
Vascular calcification is associated with aging, type 2 diabetes, and atherosclerosis, and increases the risk of cardiovascular morbidity and mortality. It is an active, highly regulated process that resembles physiological bone formation. It has previously been established that pharmacological doses of metformin alleviate arterial calcification through adenosine monophosphate-activated protein kinase (AMPK)-activated autophagy, however the specific pathway remains elusive. In the present study we hypothesized that metformin protects against arterial calcification through the direct autophagic degradation of runt-related transcription factor 2 (Runx2). Calcification was blunted in vascular smooth muscle cells (VSMCs) by metformin in a dose-dependent manner (0.5-1.5 mM) compared to control cells (p < 0.01). VSMCs cultured under high-phosphate (Pi) conditions in the presence of metformin (1 mM) showed a significant increase in LC3 puncta following bafilomycin-A1 (Baf-A; 5 nM) treatment compared to control cells (p < 0.001). Furthermore, reduced expression of Runx2 was observed in the nuclei of metformin-treated calcifying VSMCs (p < 0.0001). Evaluation of the functional role of autophagy through Atg3 knockdown in VSMCs showed aggravated Pi-induced calcification (p < 0.0001), failure to induce autophagy (punctate LC3) (p < 0.001) and increased nuclear Runx2 expression (p < 0.0001) in VSMCs cultured under high Pi conditions in the presence of metformin (1 mM). Mechanistic studies employing three-way coimmunoprecipitation with Runx2, p62, and LC3 revealed that p62 binds to both LC3 and Runx2 upon metformin treatment in VSMCs. Furthermore, immunoblotting with LC3 revealed that Runx2 specifically binds with p62 and LC3-II in metformin-treated calcified VSMCs. Lastly, we investigated the importance of the autophagy pathway in vascular calcification in a clinical setting. Ex vivo clinical analyses of calcified diabetic lower limb artery tissues highlighted a negative association between Runx2 and LC3 in the vascular calcification process. These studies suggest that exploitation of metformin and its analogues may represent a novel therapeutic strategy for clinical intervention through the induction of AMPK/Autophagy Related 3 (Atg3)-dependent autophagy and the subsequent p62-mediated autophagic degradation of Runx2.
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Affiliation(s)
- Kanchan Phadwal
- The Roslin Institute and R(D)SVS, The University of Edinburgh, Edinburgh, UK
| | - Eve Koo
- The Roslin Institute and R(D)SVS, The University of Edinburgh, Edinburgh, UK
| | - Ross A Jones
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for Motor Neurone Disease Research, The University of Edinburgh, Edinburgh, UK
| | - Rachael O Forsythe
- Centre for Cardiovascular Science, The Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Department of Vascular Surgery, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Keyi Tang
- The Roslin Institute and R(D)SVS, The University of Edinburgh, Edinburgh, UK
| | - Qiyu Tang
- The Roslin Institute and R(D)SVS, The University of Edinburgh, Edinburgh, UK
| | - Brendan M Corcoran
- The Roslin Institute and R(D)SVS, The University of Edinburgh, Edinburgh, UK
| | - Andrea Caporali
- Centre for Cardiovascular Science, The Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Vicky E MacRae
- The Roslin Institute and R(D)SVS, The University of Edinburgh, Edinburgh, UK
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Zu W, Li CC, Wang XY, Li QS, Liu B. Association of uric acid levels with cardiac syndrome X: A meta-analysis. Front Physiol 2022; 13:976190. [PMID: 36262259 PMCID: PMC9574385 DOI: 10.3389/fphys.2022.976190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/02/2022] [Indexed: 12/02/2022] Open
Abstract
Objective: The pathogenesis of elevated uric acid (UA) levels in patients with cardiac syndrome X (CSX) is unclear, and the results presented in recent papers on UA levels in patients with CSX are controversial. Therefore, we conducted a meta- analysis to assess the relationship between UA levels and CSX. Methods: Three databases, including the Web of Science, EMBASE and PubMed, were systematically searched until January 2022. Fixed-effect and random-effects models were used to analyze the relationship between UA levels and CSX. Subgroup analysis and sensitivity analysis were also performed. Results: Six studies involving 406 CSX patients and 267 non-CSX were included. Our results showed a significant relationship between UA levels and CSX, with a pooled SMD of 0.68 (95% CI 0.37 to 1.00; p < 0.0001). We also found a close relationship between UA levels and CSX for patients ≥ 55 years old (SMD:0.70, 95% CI: 0.41 to 0.99, p < 0.00001), for patients < 55 years old (SMD: 0.68, 95% CI: 0.25 to 1.12, p =0 .002), for women ≥ 60% (SMD: 0.77, 95% CI: 0.33 to 1.14, p =0 .0004), for women < 60% (SMD: 0.61, 95% CI:0.23 to 0.98, p =0 .001), for BMI ≥ 28 Kg/m2 (SMD :0.61, 95% CI: 0.23 to 0.98, p =0 .001), for BMI < 28 Kg/m2 (SMD:0.75, 95% CI: 0.31 to 1.19, p =0 .0009), for publication years ≥ 2012 (SMD :0.69, 95% CI: 0.23 to 1.15, p = 0.003), for publication years < 2012 (SMD:0.73, 95% CI:0.41 to 1.05, p < 0.00001), and for Turkey (SMD:0.75, 95% CI:0.38 to 1.11, p <.0001). Sensitivity analysis showed that the pooled results remained consistent after removing any one study or converting the random-effects model to fixed-effects model. Conclusion: Our results indicated a strong association between high UA levels and CSX. However, more well-designed studies are needed to investigate whether early treatment of hyperuricemia can reduce the incidence of CSX.
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Affiliation(s)
- Wu Zu
- Department of Cardiology, General Hospital of Fuxin Mining Industry Group of Liaoning Health Industry Group, Fuxin, China
| | - Chen-Chen Li
- Department of Nephrology, General Hospital of Fuxin Mining Industry Group of Liaoning Health Industry Group, Fuxin, China
| | - Xin-Yu Wang
- Department of Emergency, General Hospital of Fuxin Mining Industry Group of Liaoning Health Industry Group, Fuxin, China
| | - Qiu-Shi Li
- Department of Cardiology, General Hospital of Fuxin Mining Industry Group of Liaoning Health Industry Group, Fuxin, China
| | - Bing Liu
- Department of Cardiology, General Hospital of Fuxin Mining Industry Group of Liaoning Health Industry Group, Fuxin, China
- *Correspondence: Bing Liu,
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Wittekoek ME, Piek JJ. Non-obstructive cardiovascular disease: a new challenge for invasive cardiology? Neth Heart J 2018; 26:1-2. [PMID: 29188539 PMCID: PMC5758453 DOI: 10.1007/s12471-017-1062-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
| | - J J Piek
- AMC Heart Center, Academic Medical Center, Amsterdam, The Netherlands
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Liang KW, Sheu WHH, Lee WJ, Lee WL, Fu CP, Wang JS. Differential expression of circulating vascular cell adhesion molecule-1 in subjects with coronary artery disease and cardiac syndrome X without known diabetes mellitus. Biomarkers 2017; 22:798-804. [PMID: 28675064 DOI: 10.1080/1354750x.2017.1351003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
CONTEXT Inflammation is one of the mechanisms underlying cardiac syndrome X (CSX). OBJECTIVES Few studies have compared the expression of inflammatory or adhesion molecules between coronary artery disease (CAD) versus CSX. MATERIALS AND METHODS Ninety-two CSX and 145 CAD subjects without known diabetes mellitus underwent coronary angiogram for angina. RESULTS Vascular cell adhesion molecule (VCAM)-1 (median, 507 versus 431 ng/ml, p = 0.001) was significantly higher in the CAD group. In the binary regression, VCAM-1 was a significant differential factor for CAD versus CSX. DISCUSSION AND CONCLUSION Adhesion molecules might be implicated in the differential expression of macro versus microvascular coronary disease. TRIAL REGISTRATION NUMBER NCT01198730 at https://clinicaltrials.gov.
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Affiliation(s)
- Kae-Woei Liang
- a Cardiovascular Center , Taichung Veterans General Hospital , Taichung , Taiwan.,b School of Medicine , National Yang Ming University , Taipei , Taiwan.,c Department of Medicine , China Medical University , Taichung , Taiwan
| | - Wayne H-H Sheu
- b School of Medicine , National Yang Ming University , Taipei , Taiwan.,d Division of Endocrinology and Metabolism, Department of Medicine , Taichung Veterans General Hospital , Taichung , Taiwan.,e Institute of Biomedical Sciences , National Chung Hsing University , Taichung , Taiwan.,f School of Medicine , National Defense Medical Center , Taipei , Taiwan
| | - Wen-Jane Lee
- g Department of Medical Research , Taichung Veterans General Hospital , Taichung , Taiwan.,h Tung-Hai University , Taichung , Taiwan
| | - Wen-Lieng Lee
- a Cardiovascular Center , Taichung Veterans General Hospital , Taichung , Taiwan.,b School of Medicine , National Yang Ming University , Taipei , Taiwan
| | - Chia-Po Fu
- d Division of Endocrinology and Metabolism, Department of Medicine , Taichung Veterans General Hospital , Taichung , Taiwan
| | - Jun-Sing Wang
- b School of Medicine , National Yang Ming University , Taipei , Taiwan.,d Division of Endocrinology and Metabolism, Department of Medicine , Taichung Veterans General Hospital , Taichung , Taiwan
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Murphy MO, Loria AS. Sex-specific effects of stress on metabolic and cardiovascular disease: are women at higher risk? Am J Physiol Regul Integr Comp Physiol 2017; 313:R1-R9. [PMID: 28468942 DOI: 10.1152/ajpregu.00185.2016] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 04/18/2017] [Accepted: 04/28/2017] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease (CVD) has traditionally been viewed as a male disease; however, the relative risk for obesity and hypertension morbidity and mortality, major risk factors for CVD, is higher for women in the United States. Emerging epidemiological data strongly support stressful experiences as a modifiable risk factor for obesity, insulin resistance, and heart disease in women at all ages. Therefore, primary prevention of these diseases may be associated with both identifying and increasing the knowledge regarding the sex differences in emotional functioning associated with physiological responses to stress. The purpose of this review is to highlight the growing body of clinical and experimental studies showing that stress, obesity-associated metabolic disturbances, and CVD comorbidities are more prevalent in females. Overall, this review reveals the need for investigations to decipher the early origins of these comorbidities. Targeting the sources of behavioral/emotional stress through the trajectory of life has the potential to reduce the alarming projected rates for chronic disease in women.
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Affiliation(s)
- Margaret O Murphy
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky
| | - Analia S Loria
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky
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Lutfi MF. Ventricular late potential in cardiac syndrome X compared to coronary artery disease. BMC Cardiovasc Disord 2017; 17:35. [PMID: 28103808 PMCID: PMC5244555 DOI: 10.1186/s12872-017-0469-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 01/13/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although ventricular late potential (VLP) was extensively studied in risk stratification of myocardial infarction (MI) patients, comparable researches evaluating presence of VLP in MI-free coronary artery disease (CAD) and cardiac syndrome X (CSX) subjects are scarce. This study aimed to compare presence of VLP between CSX and CAD patients. METHODS Signal average ECG (SAECG) was performed to 49 patients with a history of typical cardiac pain before undergoing diagnostic coronary angiography (DCA) in Al-Shaab cardiac center, Khartoum, Sudan. QRS duration, duration of the terminal part of the QRS complex with amplitude less than 40 microvolts (LAS40) and the root mean square voltage of the terminal 40 milliseconds (RMS40) of the filtered QRS complex were identified for each patient. Presence of two or more of QRS duration > 120 ms, RMS40 > 38 ms and LAS40 < 20 μV was considered indicative of VLP. Associations between VLP and patients grouped according to DCA results were assessed using appropriate statistical tests. RESULTS VLP was present in 11.11% (3.63%-24.66%) and 15.38% (2.66%-42.23%) of patients with CAD and CSX respectively. Presence of VLP was comparable in patients with CAD and CSX (OR = 0.69, 95% CI = 0.11-6.05, P = 0.692), even after controlling for the possible variations in gender, age, body mass index (BMI), hypertension and diabetes mellitus in the studied groups. CONCLUSION Presence of VLP is comparable among CSX and CAD patients.
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Affiliation(s)
- Mohamed Faisal Lutfi
- Department of Physiology, Faculty of Medicine and Health Sciences, Al-Neelain University, Khartoum, Sudan.
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Liang KW, Sheu WHH, Lee WJ, Lee WL, Pan HC, Lee IT, Wang JS. Post-challenge insulin concentration is useful for differentiating between coronary artery disease and cardiac syndrome X in subjects without known diabetes mellitus. Diabetol Metab Syndr 2017; 9:10. [PMID: 28194232 PMCID: PMC5299675 DOI: 10.1186/s13098-017-0209-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 01/29/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cardiac syndrome X (CSX) is characterized by angina pectoris but with patent coronary arteries. Our previous study demonstrated that subjects with CSX had a higher fasting insulin-resistance (IR) than the controls. However, few studies have investigated the degree of IR, including oral glucose tolerance test (OGTT)-derived indices and profiles of metabolic abnormalities between CSX and coronary artery disease (CAD). METHODS Ninety-two CSX and 145 CAD subjects without known diabetes mellitus (DM) underwent coronary angiogram (CAG) for angina pectoris and also agreed to receive OGTT and glycated hemoglobin (HbA1C) evaluations for screening abnormal glucose regulation and IR. RESULTS CAD group had more subjects with metabolically unhealthy obesity (52.4 vs. 31.5%, p < 0.001) than the CSX group. The CAD group had higher OGTT 2 h glucose and insulin (both p < 0.005) while fasting glucose, insulin and HOMA-IR were similar to those of CSX subjects. In the binary regression analysis, OGTT 2 h insulin and being metabolic unhealthy were significantly different between the CAD and CSX groups, but there were no significant differences in Matsuda index, fasting glucose, insulin, HOMA-IR, or HbA1C. CONCLUSIONS Post challenge OGTT 2 h insulin and being metabolic unhealthy were useful parameters in differentiating between CAD and CSX in subjects without known DM but suffered from angina pectoris and underwent CAG. Different degrees of IR and metabolic abnormalities might be implicated in the pathogenesis of micro vs. macro vascular coronary diseases. Trial registration NCT01198730 at https://clinicaltrials.gov, Registered Sep. 8, 2010.
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Affiliation(s)
- Kae-Woei Liang
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung, 40705 Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
- Department of Medicine, China Medical University, Taichung, Taiwan
| | - Wayne H.-H. Sheu
- School of Medicine, National Yang Ming University, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Jane Lee
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Tung-Hai University, Taichung, Taiwan
| | - Wen-Lieng Lee
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung, 40705 Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Hung-Chih Pan
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung, 40705 Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - I.-Te Lee
- School of Medicine, National Yang Ming University, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
| | - Jun-Sing Wang
- School of Medicine, National Yang Ming University, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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Alrifai A, Kabach M, Nieves J, Pino J, Chait R. Microvascular Coronary Artery Disease: Review Article. US CARDIOLOGY REVIEW 2017. [DOI: 10.15420/usc.2017:27:1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Recently it has become more apparent that microvascular dysfunction is responsible for morbidity and mortality in many different cardiovascular diseases. It is no longer felt to be benign, and besides accounting for angina symptoms, it likely plays a role in heart failure with preserved ejection fraction, as well as in Takotsubo syndrome and various inflammatory diseases associated with ischemia and atherosclerosis. Coronary microvascular disease can be diagnosed by means of invasive coronary reactivity testing and noninvasively by echocardiography, computerized tomography, magnetic resonance, and positron emission tomography. Unfortunately, treatment has been more empiric, and not as well evaluated by randomized trials as in other disease states. Beta blockers, nitrates, and calcium channel blockers have all been used with varying degrees of success. Given its prevalence, particularly among women, its increased recognition and importance mandates further research into prompt diagnosis and more robust studies of its treatment.
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Nascimento AR, Machado MV, Gomes F, Vieira AB, Gonçalves-de-Albuquerque CF, Lessa MA, Bousquet P, Tibiriçá E. Central Sympathetic Modulation Reverses Microvascular Alterations in a Rat Model of High-Fat Diet-Induced Metabolic Syndrome. Microcirculation 2016; 23:320-9. [DOI: 10.1111/micc.12280] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 04/14/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Alessandro R. Nascimento
- Laboratory of Cardiovascular Investigation; Oswaldo Cruz Institute; FIOCRUZ; Rio de Janeiro Brazil
- Laboratory of Neurobiology and Cardiovascular Pharmacology; EA 7296; Faculty of Medicine of the University of Strasbourg; Strasbourg France
| | - Marcus V. Machado
- Laboratory of Cardiovascular Investigation; Oswaldo Cruz Institute; FIOCRUZ; Rio de Janeiro Brazil
| | - Fabiana Gomes
- Laboratory of Cardiovascular Investigation; Oswaldo Cruz Institute; FIOCRUZ; Rio de Janeiro Brazil
| | - Aline B. Vieira
- Laboratory of Inflammation Oswaldo Cruz Institute; FIOCRUZ; Rio de Janeiro Brazil
| | | | - Marcos A. Lessa
- Laboratory of Cardiovascular Investigation; Oswaldo Cruz Institute; FIOCRUZ; Rio de Janeiro Brazil
| | - Pascal Bousquet
- Laboratory of Neurobiology and Cardiovascular Pharmacology; EA 7296; Faculty of Medicine of the University of Strasbourg; Strasbourg France
| | - Eduardo Tibiriçá
- Laboratory of Cardiovascular Investigation; Oswaldo Cruz Institute; FIOCRUZ; Rio de Janeiro Brazil
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Abstract
Cardiac Syndrome X (CSX), characterized by angina-like chest discomfort, ST segment depression during exercise, and normal epicardial coronary arteries at angiography, is highly prevalent in women. CSX is not benign, and linked to adverse cardiovascular outcomes and a poor quality of life. Coronary microvascular and endothelial dysfunction and abnormal cardiac nociception have been implicated in the pathogenesis of CSX. Treatment includes life-style modification, anti-anginal, anti-atherosclerotic, and anti-ischemic medications. Non-pharmacological options include cognitive behavioral therapy, enhanced external counterpulsation, neurostimulation, and stellate ganglionectomy. Studies have shown the efficacy of individual treatments but guidelines outlining the best course of therapy are lacking.
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Affiliation(s)
- Shilpa Agrawal
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Puja K Mehta
- Department of Medicine, Cedars-Sinai Medical Center, Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, 127 South San Vicente Boulevard, Los Angeles, CA 90048, USA.
| | - C Noel Bairey Merz
- Department of Medicine, Cedars-Sinai Medical Center, Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, 127 South San Vicente Boulevard, Los Angeles, CA 90048, USA
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Hellmann M, Roustit M, Cracowski JL. Skin microvascular endothelial function as a biomarker in cardiovascular diseases? Pharmacol Rep 2015; 67:803-10. [DOI: 10.1016/j.pharep.2015.05.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/13/2015] [Accepted: 05/13/2015] [Indexed: 11/17/2022]
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Liang KW, Lee WJ, Lee WL, Liao YC, Wang KY, Lee IT, Wang JS, Sheu WHH. Circulating adipokines and insulin resistance in subjects with combined cardiac and metabolic syndrome X. Diabetol Metab Syndr 2015; 7:83. [PMID: 26413164 PMCID: PMC4583190 DOI: 10.1186/s13098-015-0078-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 09/17/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Cardiac syndrome X (CSX) is characterized by angina pectoris but with patent coronary arteries. Our previous study showed that CSX subjects had decreased serum adiponectin but higher leptin and insulin resistance (IR). However, few studies have investigated circulating adipokines and IR in subjects with combined metabolic syndrome X (MetX) and CSX. METHODS Fifty-nine subjects with CSX were retrospectively enrolled from our cardiac catheterization patient databank. Fifty-four subjects with valvular heart disease or arrhythmia and with normal coronary angiograms were recruited as the non-CSX comparison group. The study subjects were reclassified according to the presence or absence of MetX. Circulating adipokines and degree of IR were measured. RESULTS Subjects with combined MetX and CSX had a significantly higher HOMA-IR, a higher circulating leptin level (median 8.7 vs. 3.3 ng/mL, p < 0.001), but a lower circulating adiponectin level (median 2.8 vs. 12.3 μg/mL, p < 0.001) than those without MetX and CSX. In pairwise comparisons, combined MetX and CSX subjects had a similar circulating adipokines and IR index as those who had only either one syndrome X. In a multivariate regression analysis, serum triglycerides (odds ratio 1.011, p = 0.024) and hypertension (odds ratio 14.453, p = 0.003) were independently associated with diagnosis of combined MetX and CSX. CONCLUSIONS Combined MetX and CSX had a significantly higher HOMA-IR, a higher circulating leptin but a lower circulating adiponectin level than those without MetX and CSX. Combined syndrome X did not confer more changes on adipokines or IR index comparing with those with only one syndrome X.
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Affiliation(s)
- Kae-Woei Liang
- />Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung, 40705 Taiwan
- />School of Medicine, National Yang Ming University, Taipei, Taiwan
- />Department of Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Jane Lee
- />Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- />Tung-Hai University, Taichung, Taiwan
| | - Wen-Lieng Lee
- />Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung, 40705 Taiwan
- />School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Ying-Chieh Liao
- />Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung, 40705 Taiwan
- />School of Medicine, National Yang Ming University, Taipei, Taiwan
- />Taichung Tzu Chi Hospital, Taichung, Taiwan
- />Department of Medicine, Tzu Chi University School of Medicine, Hualian, Taiwan
| | - Kuo-Yang Wang
- />Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung, 40705 Taiwan
- />School of Medicine, National Yang Ming University, Taipei, Taiwan
- />Department of Medicine, China Medical University, Taichung, Taiwan
- />Department of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - I.-Te Lee
- />School of Medicine, National Yang Ming University, Taipei, Taiwan
- />Department of Medicine, Chung Shan Medical University, Taichung, Taiwan
- />Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung, 40705 Taiwan
| | - Jun-Sing Wang
- />School of Medicine, National Yang Ming University, Taipei, Taiwan
- />Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung, 40705 Taiwan
| | - Wayne H.-H. Sheu
- />School of Medicine, National Yang Ming University, Taipei, Taiwan
- />Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sec. 4, Taichung, 40705 Taiwan
- />Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
- />School of Medicine, National Defense Medical Center, Taipei, Taiwan
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Abstract
Cardiac Syndrome X (CSX), characterized by angina-like chest discomfort, ST segment depression during exercise, and normal epicardial coronary arteries at angiography, is highly prevalent in women. CSX is not benign, and linked to adverse cardiovascular outcomes and a poor quality of life. Coronary microvascular and endothelial dysfunction and abnormal cardiac nociception have been implicated in the pathogenesis of CSX. Treatment includes life-style modification, anti-anginal, anti-atherosclerotic, and anti-ischemic medications. Non-pharmacological options include cognitive behavioral therapy, enhanced external counterpulsation, neurostimulation, and stellate ganglionectomy. Studies have shown the efficacy of individual treatments but guidelines outlining the best course of therapy are lacking.
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Affiliation(s)
- Shilpa Agrawal
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Puja K Mehta
- Department of Medicine, Cedars-Sinai Medical Center, Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, 127 South San Vicente Boulevard, Los Angeles, CA 90048, USA.
| | - C Noel Bairey Merz
- Department of Medicine, Cedars-Sinai Medical Center, Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, 127 South San Vicente Boulevard, Los Angeles, CA 90048, USA
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Kuruvilla S, Kramer CM. Coronary microvascular dysfunction in women: an overview of diagnostic strategies. Expert Rev Cardiovasc Ther 2014; 11:1515-25. [PMID: 24160578 DOI: 10.1586/14779072.2013.833854] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Coronary microvascular dysfunction (CMD) also known as syndrome X, is characterized by typical anginal symptoms, evidence of myocardial ischemia on non-invasive testing and normal to minimal coronary disease on coronary angiography. It has a female preponderance and has been detected in up to 50% of women presenting with chest pain symptoms. Definitive diagnosis of CMD is critical as recent evidence suggests that women with this condition are at increased risk of cardiovascular events in the future. Invasive coronary reactivity testing on coronary angiography is considered to be the 'gold standard' for diagnosis of CMD. Non-invasive imaging techniques such as PET and cardiac magnetic resonance hold promise for detection of CMD in the future.
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Affiliation(s)
- Sujith Kuruvilla
- Department of Medicine (Cardiology), University of Virginia Health System, Charlottesville, VA, USA and
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L-NAME iontophoresis: a tool to assess NO-mediated vasoreactivity during thermal hyperemic vasodilation in humans. J Cardiovasc Pharmacol 2013; 61:361-8. [PMID: 23318989 DOI: 10.1097/fjc.0b013e3182858f81] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Decreased endothelial Nitric oxide (NO) bioavailability is one of the earliest events of endothelial dysfunction. Assessment of microvascular blood flow using a Laser Doppler Imager during local noninvasive administration of L-N-Arginine-Methyl-Ester (L-NAME) by skin iontophoresis may help discriminate the relative contributions of NO and non-NO pathways during a skin thermal hyperemic test. METHODS In healthy nonsmokers, the effects of thermal vasodilation and sodium nitroprusside-mediated vasodilation were tested on skin pretreated with 0.9% saline solution, 2% L-NAME iontophoresis (n = 12), or intradermal injection of 25 nmol L-NAME (n = 10). The effects of L-NAME iontophoresis were also measured in a group of smokers (n = 10). RESULTS L-NAME iontophoresis and intradermal injection of L-NAME decreased the skin response to local heating to a similar degree (-41% ± 4% vs. -44% ± 6%). L-NAME iontophoresis site-to-site and day-to-day coefficients of correlation were 0.83 and 0.76, respectively (P < 0.01). The site-to-site and day-to-day coefficients of correlation of L-NAME injection were lower than those of iontophoresis at 0.66 (P < 0.05) and 0.12, respectively (P = not significant). Sodium nitroprusside-induced skin hyperemia was not affected by L-NAME administration. L-NAME iontophoresis-mediated inhibition of skin thermal hyperemia was greater in smokers than in nonsmokers (P < 0.05). CONCLUSIONS Laser Doppler Imager assessment of skin thermal hyperemia after L-NAME iontophoresis provides a reproducible and selective bedside method of qualitatively analyzing the contribution of the NO pathway to microvascular vasomotor function.
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Wauters A, Dreyfuss C, Pochet S, Hendrick P, Berkenboom G, van de Borne P, Argacha JF. Acute exposure to diesel exhaust impairs nitric oxide-mediated endothelial vasomotor function by increasing endothelial oxidative stress. Hypertension 2013; 62:352-8. [PMID: 23798345 DOI: 10.1161/hypertensionaha.111.00991] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Exposure to diesel exhaust was recently identified as an important cardiovascular risk factor, but whether it impairs nitric oxide (NO)-mediated endothelial function and increases production of reactive oxygen species (ROS) in endothelial cells is not known. We tested these hypotheses in a randomized, controlled, crossover study in healthy male volunteers exposed to ambient and polluted air (n=12). The effects of skin microvascular hyperemic provocative tests, including local heating and iontophoresis of acetylcholine and sodium nitroprusside, were assessed using a laser Doppler imager. Before local heating, skin was pretreated by iontophoresis of either a specific NO-synthase inhibitor (L-N-arginine-methyl-ester) or a saline solution (Control). ROS production was measured by chemiluminescence using the lucigenin technique in human umbilical vein endothelial cells preincubated with serum from 5 of the subjects. Exposure to diesel exhaust reduced acetylcholine-induced vasodilation (P<0.01) but did not affect vasodilation with sodium nitroprusside. Moreover, the acetylcholine/sodium nitroprusside vasodilation ratio decreased from 1.51 ± 0.1 to 1.06 ± 0.07 (P<0.01) and was correlated to inhaled particulate matter 2.5 (r=-0.55; P<0.01). NO-mediated skin thermal vasodilatation decreased from 466 ± 264% to 29 ± 123% (P<0.05). ROS production was increased after polluted air exposure (P<0.01) and was correlated with the total amount of inhaled particulate matter <2.5 μm (PM2.5). In healthy subjects, acute experimental exposure to diesel exhaust impaired NO-mediated endothelial vasomotor function and promoted ROS generation in endothelial cells. Increased PM2.5 inhalation enhances microvascular dysfunction and ROS production.
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Affiliation(s)
- Aurélien Wauters
- Department of Cardiology, Erasme Hospital, 808 Lennik St, 1070 Brussels, Belgium.
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Pre-diabetes, metabolic syndrome, and cardiovascular risk. J Am Coll Cardiol 2012; 59:635-43. [PMID: 22322078 DOI: 10.1016/j.jacc.2011.08.080] [Citation(s) in RCA: 383] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 08/17/2011] [Accepted: 08/23/2011] [Indexed: 12/11/2022]
Abstract
Pre-diabetes represents an elevation of plasma glucose above the normal range but below that of clinical diabetes. Pre-diabetes can be identified as either impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). The latter is detected by oral glucose tolerance testing. Both IFG and IGT are risk factors for type 2 diabetes, and risk is even greater when IFG and IGT occur together. Pre-diabetes commonly associates with the metabolic syndrome. Both in turn are closely associated with obesity. The mechanisms whereby obesity predisposes to pre-diabetes and metabolic syndrome are incompletely understood but likely have a common metabolic soil. Insulin resistance is a common factor; systemic inflammation engendered by obesity may be another. Pre-diabetes has only a minor impact on microvascular disease; glucose-lowering drugs can delay conversion to diabetes, but whether in the long run the drug approach will delay development of microvascular disease is in dispute. To date, the drug approach to prevention of microvascular disease starting with pre-diabetes has not been evaluated. Pre-diabetes carries some predictive power for macrovascular disease, but most of this association appears to be mediated through the metabolic syndrome. The preferred clinical approach to cardiovascular prevention is to treat all the metabolic risk factors. For both pre-diabetes and metabolic syndrome, the desirable approach is lifestyle intervention, especially weight reduction and physical activity. When drug therapy is contemplated and when the metabolic syndrome is present, the primary consideration is prevention of cardiovascular disease. The major targets are elevations of cholesterol and blood pressure.
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20
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Park C, Bathula R, Shore AC, Tillin T, Strain WD, Chaturvedi N, Hughes AD. Impaired post-ischaemic microvascular hyperaemia in Indian Asians is unexplained by diabetes or other cardiovascular risk factors. Atherosclerosis 2011; 221:503-7. [PMID: 22341592 DOI: 10.1016/j.atherosclerosis.2011.11.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 11/07/2011] [Accepted: 11/18/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE People of Indian Asian descent have an increased risk of cardiovascular disease (CVD) that cannot be explained by diabetes and other established CVD risk factors. We investigated if microcirculatory function was impaired in a population-based sample of people of Indian Asian descent compared with Europeans in the UK and whether any differences could be accounted for by diabetes or other CVD risk factors. RESEARCH DESIGN AND METHODS Cutaneous microvascular function was assessed using laser Doppler fluximetry in response to heating to 42 °C (maximum hyperaemia) and 3 min arterial occlusion (post occlusive reactive hyperaemia: PORH) in 148 Indian Asians and 147 Europeans. Blood pressure, anthropometry and fasting bloods were also measured. RESULTS Maximum hyperaemia and minimum resistance did not differ significantly by ethnicity. Resting flux and PORH were lower in Indian Asians and time to peak of PORH was prolonged. Diabetes was associated with reduced maximum hyperaemia and PORH. Adjustment for diabetes accounted for differences in resting flux and time to peak but not differences in PORH (Europeans = 45.0 (40.3, 50.1)au, Indian Asians = 35.6 (31.9, 39.7)au, mean (95% confidence interval); p = 0.008 after adjustment). Differences in conventional CVD risk factors did not account for interethnic differences in microvascular responses. CONCLUSIONS People of Indian Asian descent have impaired post-occlusive reactive hyperaemia unexplained by diabetes, dysglycaemia or other CVD risk factors. Abnormal microvascular function in response to ischaemia could represent a novel mechanism contributing to the elevated risk of CVD in Indian Asians.
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Affiliation(s)
- C Park
- International Centre for Circulatory Health, NHLI Division, Faculty of Medicine, Imperial College London & Imperial College Healthcare NHS Trust, London, UK
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Likelihood of obstructive coronary disease in metabolic syndrome patients with abnormal stress echocardiography. Int J Cardiol 2011; 152:207-11. [DOI: 10.1016/j.ijcard.2010.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 06/02/2010] [Accepted: 07/04/2010] [Indexed: 01/15/2023]
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Banks K, Lo M, Khera A. Angina in Women without Obstructive Coronary Artery Disease. Curr Cardiol Rev 2011; 6:71-81. [PMID: 21286281 PMCID: PMC2845797 DOI: 10.2174/157340310790231608] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Accepted: 10/08/2009] [Indexed: 11/22/2022] Open
Abstract
Angina in the absence of obstructive coronary artery disease, sometimes referred to as cardiac syndrome X (CSX), is a debilitating condition that disproportionately affects women. More than 50% of women evaluated for angina have non-obstructive disease by cardiac catheterization, although the total numbers of women affected by CSX are unknown. Varying clinical definitions and the lack of large scale epidemiologic studies focusing on this illness have resulted in limited knowledge about its risk factors, although there appears to be an association with black race, estrogen deficiency, and insulin resistance. Contrary to prior beliefs about the benign nature of this entity, these women suffer considerable morbidity with costly economic implications that approach the lifetime costs of healthcare utilization for those with obstructive coronary disease. Two prevailing hypotheses have emerged to explain CSX: the ischemic hypothesis detailing abnormal coronary microvascular function and the non-ischemic hypothesis describing altered pain perception and myocardial hypersensitivity. Treatment strategies have focused on both of these pathways with the main goal of improving symptoms. Beta blockers provide the most convincing evidence for benefit, with other antianginals having secondary roles. Other promising pharmacologic therapies include xanthine derivatives, estrogen replacement therapy, ACE inhibitors, and statin medications, among other emerging treatment options. Neurostimulation and lifestyle factors including exercise can also be beneficial in reducing symptoms. However, managing patients with CSX can be frustrating for both patients and physicians, as there is a lack of data regarding an optimal treatment algorithm including few large-scale randomized controlled trials to clarify effective therapies.
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Affiliation(s)
- Kamakki Banks
- From the Donald W. Reynolds Cardiovascular Clinical Research Center, the University of Texas Southwestern Medical Center, Dallas TX
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Dabek J, Wilczok J, Kulach A, Gasior Z. Altered transcriptional activity of gene encoding GAPDH in peripheral blood mononuclear cells from patients with cardiac syndrome X - an important part in pathology of microvascular angina? Arch Med Sci 2010; 6:709-12. [PMID: 22419929 PMCID: PMC3298339 DOI: 10.5114/aoms.2010.17085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2009] [Revised: 10/01/2009] [Accepted: 10/10/2009] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Cardiac syndrome X (CSX) is characterized by anginal pain with ECG suggestive of ischaemia and normal coronary arteries at angiography. Pathology of CSX involves microvascular dysfunction and is possibly linked with metabolic syndrome. Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) is an enzyme involved in glycolysis. The GAPDH gene is a "housekeeping" gene and is used for normalization in quantitative gene expression assays. The aim of the study was to evaluate GAPDH gene expression in CSX. MATERIAL AND METHODS The study was performed in 35 CSX patients and 10 control subjects. mRNA was extracted from peripheral blood mononuclears and the mRNA was assessed by QRT-PCR. RESULTS GAPDH gene expression was enhanced in CSX patients vs. controls (93022 ±23837 copies/μg vs. 1067 ±240 copies/μg respectively; p < 0.001). Moreover, transcriptional activity of the GAPDH gene was heterogeneous within the CSX group. CONCLUSIONS GAPDH gene expression is markedly enhanced in CSX, which reflects carbohydrate metabolism disturbances and makes the GAPDH gene unsuitable as an endogenous control in patients with CSX.
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Affiliation(s)
- Jozefa Dabek
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Jakub Wilczok
- Department of Molecular Biology and Medical Genetics, Medical University of Silesia, Sosnowiec, Poland
| | - Andrzej Kulach
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Zbigniew Gasior
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
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Vermeltfoort IAC, Raijmakers PGHM, Riphagen II, Odekerken DAM, Kuijper AFM, Zwijnenburg A, Teule GJJ. Definitions and incidence of cardiac syndrome X: review and analysis of clinical data. Clin Res Cardiol 2010; 99:475-81. [PMID: 20407906 PMCID: PMC2911526 DOI: 10.1007/s00392-010-0159-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Accepted: 04/07/2010] [Indexed: 01/18/2023]
Abstract
There is no consensus regarding the definition of cardiac syndrome X (CSX). We systematically reviewed recent literature using a standardized search strategy. We included 57 articles. A total of 47 studies mentioned a male/female distribution. A meta-analysis yielded a pooled proportion of females of 0.56 (n = 1,934 patients, with 95% confidence interval: 0.54-0.59). As much as 9 inclusion criteria and 43 exclusion criteria were found in the 57 articles. Applying these criteria to a population with normal coronary angiograms and treated in 1 year at a general hospital, the attributable CSX incidence varied between 3 and 11%. The many inclusion and exclusion criteria result in a wide range of definitions of CSX and these have large effects on the incidence. This shows the need for a generally accepted definition of CSX.
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Affiliation(s)
- I A C Vermeltfoort
- Department of Nuclear Medicine and PET Research, VU University Medical Centre, Amsterdam, The Netherlands.
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Kayaalti F, Kalay N, Basar E, Mavili E, Duran M, Ozdogru I, Dogan A, Inanc MT, Kaya MG, Topsakal R, Oguzhan A. Effects of nebivolol therapy on endothelial functions in cardiac syndrome X. Heart Vessels 2010; 25:92-6. [PMID: 20339969 DOI: 10.1007/s00380-009-1170-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Accepted: 04/19/2009] [Indexed: 12/25/2022]
Affiliation(s)
- Fatma Kayaalti
- Department of Cardiology, Erciyes University Medicine Faculty, Kayseri, 38000, Turkey
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Effect of weight loss after bariatric surgery on skin and the extracellular matrix. Plast Reconstr Surg 2010; 125:343-351. [PMID: 20048625 DOI: 10.1097/prs.0b013e3181c2a657] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Obese patients experience dramatic physical and metabolic changes in the skin and its collagen. Bariatric surgery is known to result in significant improvement in obesity-associated comorbid conditions and metabolic disturbances. The aim of this study was to evaluate skin quality following weight loss surgery and its suitability to produce an extracellular matrix for use in reconstructive procedures. METHODS During circumferential lipectomy, skin tissue was obtained from 10 patients following bariatric surgery. The samples were subjected to histologic examination and to study by differential scanning calorimetry. A retrospective review of patient records was used to determine time between bariatric and body lift procedures and to identify subject demographic and clinical data, including body mass index, excess weight loss, and comorbid conditions. RESULTS Plastic surgery followed bariatric surgery by 20.5 +/- 11 months, and patients experienced an average weight loss of 132.1 +/- 61.0 lb. Histologic evaluation of post-bariatric surgery skin samples showed a poorly organized collagen structure, elastin degradation, and regions of scar formation within macroscopically normal areas. Differential scanning calorimetry showed increased enthalpy of phase transition and decreased onset temperature for collagen denaturation in striae distensae samples compared with bulk bariatric skin samples, consistent with tissue matrix degradation in striae. CONCLUSION Skin tissue in this patient population exhibited significant signs of damage to extracellular matrix components despite the duration of time since the bariatric procedure.
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Bender SB, Tune JD, Borbouse L, Long X, Sturek M, Laughlin MH. Altered mechanism of adenosine-induced coronary arteriolar dilation in early-stage metabolic syndrome. Exp Biol Med (Maywood) 2009; 234:683-92. [PMID: 19307464 DOI: 10.3181/0812-rm-350] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Onset of the combined metabolic syndrome (MetS) is a complex progressive process involving numerous cardiovascular risk factors. Although patients with established MetS exhibit reduced coronary flow reserve and individual components of the MetS reduce microvascular vasodilation, little is known concerning the impact of early-stage MetS on the mechanisms of coronary flow control. Therefore, we tested the hypothesis that coronary arteriolar dilation to adenosine is attenuated in early-stage MetS by reduced A2 receptor function and diminished K+ channel involvement. Pigs were fed control or high-fat/cholesterol diet for 9 weeks to induce early-stage MetS. Coronary atheroma was determined in vivo with intravascular ultrasound. In vivo coronary dilation was determined by intracoronary adenosine infusion. Further, apical coronary arterioles were isolated, cannulated and pressurized to 60 cmH2O for in vitro pharmacologic assessment of adenosine dilation. Coronary atheroma was not different between groups, indicating early-stage MetS. Coronary arteriolar dilation to adenosine (in vivo) and 2-chloroadenosine (2-CAD; in vitro) was similar between groups. In control arterioles, 2-CAD-mediated dilation was reduced only by selective A(2A) receptor inhibition, whereas only dual A(2A/2B) inhibition reduced this response in MetS arterioles. Arteriolar A(2B), but not A(2A), receptor protein expression was reduced by MetS. Blockade of voltage-dependent K+ (K(v)) channels reduced arteriolar sensitivity to 2-CAD in both groups, whereas ATP-sensitive K+ (K(ATP)) channel inhibition reduced sensitivity only in control arterioles. Our data indicate that the mechanisms mediating coronary arteriolar dilation to adenosine are altered in early-stage MetS prior to overt decrements in coronary vasodilator reserve.
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Affiliation(s)
- Shawn B Bender
- E102 Vet Med Bldg, Dept. of Biomedical Sciences, University of Missouri, Columbia, MO 65211, USA.
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Relationship between peripheral and coronary function using laser Doppler imaging and transthoracic echocardiography. Clin Sci (Lond) 2008; 115:295-300. [PMID: 18338981 DOI: 10.1042/cs20070431] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vascular dysfunction in the coronary and peripheral circulations is an early prognostic marker of future cardiovascular events. Measurements of coronary and peripheral vascular function in resistance vessels can be made, but rely on invasive procedures, which make them unsuitable for routine application. An assessment of the direct correlation between vascular responses in skin and coronary vessels has not been made previously. In 27 normal healthy subjects (18-55 years of age), we examined the relationship between peripheral and coronary vascular function. Cutaneous perfusion was measured using the non-invasive technique of laser Doppler imaging during iontophoresis of acetylcholine and sodium nitroprusside, and cutaneous vascular conductance was calculated (laser Doppler perfusion/mean arterial pressure). Coronary flow reserve was measured using transthoracic echocardiography during intravenous adenosine infusion. Mean diastolic velocities were measured at baseline and peak hyperaemic conditions from the Doppler signal recordings. CVR (coronary velocity reserve) was defined as the ratio of hyperaemic to basal mean diastolic velocities. There were significant positive correlations between CVR and cutaneous vascular conductance for acetylcholine (r=0.399, P=0.039) and sodium nitroprusside (r=0.446, P=0.020). These results support the idea that peripheral measurements of skin blood flow are representative of generalized microvascular function including that of the coronary circulation in normal healthy subjects.
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Abstract
BACKGROUND Endothelial dysfunction and subsequently impaired microvascular circulation are the leading mechanisms in the development of cardiac syndrome X (CSX). The study evaluated the plasma asymmetric dimethylarginine (ADMA) and L-arginine levels of the patients with CSX and the control group and aimed to determine any relationship between these parameters and epicardial coronary blood flow and myocardial tissue perfusion. METHODS The study group consisted of 32 patients (mean age: 52.6+/-9.4 years, 14 men) with typical exertional angina, positive exercise test, and normal coronary arteries diagnosed as CSX. Plasma ADMA, L-arginine levels, and L-arginine/ADMA ratio were compared with the values of the control group, which consisted of 17 age-matched and sex-matched individuals. Concentrations of L-arginine and ADMA were measured by high-performance liquid chromatography. In all the coronary territories, epicardial coronary flow was assessed by thrombolysis in myocardial infarction (TIMI) frame count (TFC) method, and tissue level perfusion, by myocardial blush grade (MBG) method. A MBG score less than 3 was considered an impaired myocardial perfusion, and a MBG score of '3' in all the coronary territories, a normal myocardial perfusion. RESULTS The plasma ADMA levels of the study group were higher than those of the control group (0.83+/-0.38 vs. 0.55+/-0.44 micromol/l, P=0.03), whereas plasma L-arginine levels were similar in both groups (70.25+/-21.89 vs. 76.09+/-18.22 micromol/l, P=0.36), resulting in a diminished L-arginine/ADMA ratio in the patients with CSX [82.3 (60.2-128.8) vs. 242.2 (76.7-386.4), P=0.003]. In CSX group, the patients with abnormal myocardial tissue perfusion had increased plasma ADMA levels compared with those with normal tissue perfusion (0.99+/-0.37 vs. 0.69+/-0.34 micromol/l, P=0.02), whereas plasma L-arginine levels were similar in both groups. No correlations were observed between TFC values and plasma ADMA, L-arginine levels, and L-arginine/ADMA ratio. Plasma ADMA levels, however, were negatively correlated with MBG scores (r=-0.349, P=0.014). CONCLUSION We have shown for the first time that in the patients with CSX, increased plasma ADMA levels might be associated with impaired myocardial tissue perfusion when assessed by MBG.
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Krentz AJ, Clough G, Byrne CD. Interactions between microvascular and macrovascular disease in diabetes: pathophysiology and therapeutic implications. Diabetes Obes Metab 2007; 9:781-91. [PMID: 17924862 DOI: 10.1111/j.1463-1326.2007.00670.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Convention partitions the complications of diabetes into two main subtypes. First are the diabetes-specific microvascular complications of retinopathy, nephropathy and neuropathy; second are the atherothrombotic macrovascular complications that account for the majority of premature deaths. Pathological interactions between microvascular and macrovascular complications, for example, nephropathy and macrovascular disease, are common. Similar mechanisms and shared risk factors drive the development and progression of both small and large vessel disease. This concept has therapeutic implications. Mounting evidence points to the need for multifactorial strategies to prevent vascular complications in subjects with diabetes and/or the metabolic syndrome. We advocate a combined therapeutic approach that addresses small and large vessel disease. Preferential use should be made of drug regimens that (i) maximize vascular protection, (ii) reduce the risk of iatrogenic vascular damage and (iii) minimize the increasing problem of polypharmacy.
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Affiliation(s)
- Andrew J Krentz
- Department of Diabetes and Endocrinology, Southampton General Hospital, Southampton SO16 6YD, UK.
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Jadhav S, Sattar N, Petrie JR, Cobbe SM, Ferrell WR. Reproducibility and Repeatability of Peripheral Microvascular Assessment Using Iontophoresis in Conjunction With Laser Doppler Imaging. J Cardiovasc Pharmacol 2007; 50:343-9. [PMID: 17878765 DOI: 10.1097/fjc.0b013e3180dca094] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Interrogation of peripheral vascular function is increasingly recognized as a noninvasive surrogate marker for coronary vascular function and carries with it important prognostic information regarding future cardiovascular risk. Laser Doppler imaging (LDI) is a completely noninvasive method for looking at peripheral microvascular function. We sought to look at reproducibility and repeatability of LDI-derived assessment of peripheral microvascular function between arms and 8 weeks apart. We used LDI in conjunction with iontophoretic application of ACh and SNP to look at endothelium-dependent and -independent microvascular function, respectively, in a mixture of women with cardiac syndrome X and healthy volunteers. We looked at variation between arms (n = 40) and variation at 8 weeks apart (n = 22). When measurements were corrected for skin resistance, there was nonsignificant variation between arms for ACh (2.7%) and SNP (3.8%) and nonsignificant temporal variation for ACh (3.5%) and SNP (4.7%). Construction of Bland-Altman plots reinforce that measurements have good repeatability. Elimination of the baseline perfusion response had deleterious effects on repeatability. LDI can be used to assess peripheral vascular response with good repeatability as long as measurements are corrected for skin resistance, which affects drug delivery. This has important implications for the future use of LDI.
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Affiliation(s)
- Sachin Jadhav
- Divisions of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, Scotland, UK.
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