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Yong J, Tian J, Yang X, Xing H, He Y, Song X. Effects of Oral Drugs on Coronary Microvascular Function in Patients Without Significant Stenosis of Epicardial Coronary Arteries: A Systematic Review and Meta-Analysis of Coronary Flow Reserve. Front Cardiovasc Med 2020; 7:580419. [PMID: 33195465 PMCID: PMC7661556 DOI: 10.3389/fcvm.2020.580419] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/14/2020] [Indexed: 12/27/2022] Open
Abstract
Objective: This study aims to investigate the impact of cardiovascular medications on the coronary flow reserve (CFR) in patients without obstructive coronary artery disease (CAD). Methods: We searched PubMed, EMBASE, and Cochrane databases from inception to 15 November 2019. Studies were included if they reported CFR from baseline to follow-up after oral drug therapy of patients without obstructive CAD. Data was pooled using random-effects modeling. The primary outcome was change in CFR from baseline to follow-up after oral drug therapy. Results: A total of 46 studies including 845 subjects were included in this study. Relative to baseline, the CFR was improved by angiotensin-converting enzymes (ACEIs), aldosterone receptor antagonists (ARBs) [standard mean difference (SMD): 1.12; 95% CI: 0.77–1.47], and statins treatments (SMD: 0.61; 95%CI: 0.36–0.85). Six to 12 months of calcium channel blocker (CCB) treatments improved CFR (SMD: 1.04; 95% CI: 0.51–1.58). Beta-blocker (SMD: 0.24; 95% CI: −0.39–0.88) and ranolazine treatment (SMD: 0.31; 95% CI: −0.39–1.01) were not associated with improved CFR. Conclusions: Therapy with ACEIs, ARBs, and statins was associated with improved CFR in patients with confirmed or suspicious CMD. CCBs also improved CFR among patients followed for 6–12 months. Beta-blocker and ranolazine had no impact on CFR.
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Affiliation(s)
- Jingwen Yong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jinfan Tian
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xueyao Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haoran Xing
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yi He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiantao Song
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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2
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Suhrs HE, Michelsen MM, Prescott E. Treatment strategies in coronary microvascular dysfunction: A systematic review of interventional studies. Microcirculation 2019; 26:e12430. [PMID: 29130567 DOI: 10.1111/micc.12430] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/06/2017] [Indexed: 12/12/2022]
Abstract
CMD has been associated with a wide spectrum of diseases and conditions, and it has proven to be a strong prognostic marker of morbidity and mortality. Despite increased attention, guideline-based treatment recommendations are lacking. We performed a systematic review of pharmacological and nonpharmacological interventions to improve coronary perfusion, assessed by IC Doppler, TTDE, PET, CMRI, transthoracic contrast perfusion echocardiography, and dilution techniques. No restrictions were made regarding the study design (randomized, placebo-controlled/randomized with active comparators/nonrandomized with or without a control group), the cardiac condition studied, or the coronary microvascular function at baseline. An electronic database search yielded 4485 records of which 80 studies met our inclusion criteria. Included studies were sorted according to intervention and study design. Studies were small and heterogeneous in methodology, and only few were placebo-controlled. Although some treatments looked promising, we found that no specific treatment was sufficiently well documented to be recommended in any patient groups. There is a need for larger well-designed clinical trials, and we suggest that future studies stratify study populations according to pathogenic mechanisms, thereby investigating whether an individualized treatment approach would be more successful.
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Affiliation(s)
- Hannah E Suhrs
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen NV, Denmark
| | - Marie M Michelsen
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen NV, Denmark
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen NV, Denmark
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3
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Potier L, Chequer R, Roussel R, Mohammedi K, Sismail S, Hartemann A, Amouyal C, Marre M, Le Guludec D, Hyafil F. Relationship between cardiac microvascular dysfunction measured with 82Rubidium-PET and albuminuria in patients with diabetes mellitus. Cardiovasc Diabetol 2018; 17:11. [PMID: 29325551 PMCID: PMC5763541 DOI: 10.1186/s12933-017-0652-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/23/2017] [Indexed: 12/14/2022] Open
Abstract
Background Albuminuria is of one the strongest predictors of cardiovascular disease (CVD) in diabetes. Diabetes is associated with cardiac microvascular dysfunction (CMD), a powerful, independent prognostic factor for cardiac mortality. The aim of this study was to evaluate the relationship between CMD and microvascular complications in patients without known CVD. Methods In this monocentric study, myocardial flow reserve (MFR) was measured with cardiac 82Rubidium positron emission tomography (Rb-PET) in 311 patients referred to nuclear medicine department of Bichat University Hospital for screening of coronary artery disease from 2012 to 2014. Patients with hemodynamically relevant stenosis on coronary angiography or myocardial ischemia on Rb-PET were excluded. Among patients with diabetes, MFR values were compared according to the presence of retinopathy and albuminuria. Results Overall, 175 patients (118 with type 2 diabetes) were included. MFR was significantly lower in patients with diabetes compared with those without diabetes (2.6 ± 1.1 vs. 3.3 ± 1.7; p < 0.005). In patients with diabetes, MFR decreased progressively in relation to albumin urinary excretion (normoalbuminuria: 2.9 ± 1.1, microalbuminuria: 2.3 ± 1.0, macroalbuminuria: 1.8 ± 0.7; p < 0.0001). MFR was not significantly different in patients with vs. without retinopathy (2.4 ± 1.0 vs. 2.7 ± 1.1, p = 0.07). Microalbuminuria and macroalbuminuria remained strongly associated with impaired MFR after multiple adjustments [odds ratio 2.6 (95% CI 1.1–8.4) and 5.3 (95% CI 1.2–44.7), respectively]. This association was confirmed when analyses were restricted to patients with low levels of coronary calcifications on computed tomography. Conclusions Impaired MFR was more frequent in patients with diabetes and was strongly associated with the degree of albuminuria suggesting that CMD and albuminuria might share common mechanisms. Electronic supplementary material The online version of this article (10.1186/s12933-017-0652-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Louis Potier
- Department of Diabetology, Endocrinology and Nutrition, DHU-FIRE, HUPNVS, AP-HP, Paris, France. .,Paris Diderot-Sorbonne Paris Cité University, Paris, France. .,Centre de Recherche des Cordeliers, INSERM, U-1138, Paris, France.
| | - Renata Chequer
- Department of Nuclear Medicine, DHU-FIRE, HUPNVS, AP-HP, Paris, France
| | - Ronan Roussel
- Department of Diabetology, Endocrinology and Nutrition, DHU-FIRE, HUPNVS, AP-HP, Paris, France.,Paris Diderot-Sorbonne Paris Cité University, Paris, France.,Centre de Recherche des Cordeliers, INSERM, U-1138, Paris, France
| | - Kamel Mohammedi
- Department of Diabetology, Endocrinology and Nutrition, DHU-FIRE, HUPNVS, AP-HP, Paris, France.,Paris Diderot-Sorbonne Paris Cité University, Paris, France.,Centre de Recherche des Cordeliers, INSERM, U-1138, Paris, France
| | - Souad Sismail
- Department of Diabetology, Endocrinology and Nutrition, DHU-FIRE, HUPNVS, AP-HP, Paris, France
| | - Agnès Hartemann
- Department of Diabetology-Metabolism, Pitié-Salpêtrière-Charles Foix Hospital, AP-HP, Paris, France.,Pierre and Marie Curie University (UPMC), Sorbonne University, Paris, France.,INSERM U-1166, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Chloé Amouyal
- Department of Diabetology-Metabolism, Pitié-Salpêtrière-Charles Foix Hospital, AP-HP, Paris, France.,Pierre and Marie Curie University (UPMC), Sorbonne University, Paris, France.,INSERM U-1166, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Michel Marre
- Department of Diabetology, Endocrinology and Nutrition, DHU-FIRE, HUPNVS, AP-HP, Paris, France.,Paris Diderot-Sorbonne Paris Cité University, Paris, France.,Centre de Recherche des Cordeliers, INSERM, U-1138, Paris, France
| | - Dominique Le Guludec
- Paris Diderot-Sorbonne Paris Cité University, Paris, France.,Department of Nuclear Medicine, DHU-FIRE, HUPNVS, AP-HP, Paris, France.,INSERM, U-1148, Paris, France
| | - Fabien Hyafil
- Paris Diderot-Sorbonne Paris Cité University, Paris, France.,Department of Nuclear Medicine, DHU-FIRE, HUPNVS, AP-HP, Paris, France.,INSERM, U-1148, Paris, France
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5
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Husarek KE, Katz PS, Trask AJ, Galantowicz ML, Cismowski MJ, Lucchesi PA. The angiotensin receptor blocker losartan reduces coronary arteriole remodeling in type 2 diabetic mice. Vascul Pharmacol 2015; 76:28-36. [PMID: 26133668 DOI: 10.1016/j.vph.2015.06.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/09/2015] [Accepted: 06/27/2015] [Indexed: 01/02/2023]
Abstract
Cardiovascular complications are a leading cause of morbidity and mortality in type 2 diabetes mellitus (T2DM) and are associated with alterations of blood vessel structure and function. Although endothelial dysfunction and aortic stiffness have been documented, little is known about the effects of T2DM on coronary microvascular structural remodeling. The renin-angiotensin-aldosterone system plays an important role in large artery stiffness and mesenteric vessel remodeling in hypertension and T2DM. The goal of this study was to determine whether the blockade of AT1R signaling dictates vascular smooth muscle growth that partially underlies coronary arteriole remodeling in T2DM. Control and db/db mice were given AT1R blocker losartan via drinking water for 4 weeks. Using pressure myography, we found that coronary arterioles from 16-week db/db mice undergo inward hypertrophic remodeling due to increased wall thickness and wall-to-lumen ratio with a decreased lumen diameter. This remodeling was accompanied by decreased elastic modulus (decreased stiffness). Losartan treatment decreased wall thickness, wall-to-lumen ratio, and coronary arteriole cell number in db/db mice. Losartan treatment did not affect incremental elastic modulus. However, losartan improved coronary flow reserve. Our data suggest that Ang II-AT1R signaling mediates, at least in part, coronary arteriole inward hypertrophic remodeling in T2DM without affecting vascular mechanics, further suggesting that targeting the coronary microvasculature in T2DM may help reduce cardiac ischemic events.
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Affiliation(s)
- Kathryn E Husarek
- Center for Cardiovascular and Pulmonary Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States; School of Biomedical Science, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Paige S Katz
- Center for Cardiovascular and Pulmonary Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States; Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Aaron J Trask
- Center for Cardiovascular and Pulmonary Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Maarten L Galantowicz
- Center for Cardiovascular and Pulmonary Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Mary J Cismowski
- Center for Cardiovascular and Pulmonary Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Pamela A Lucchesi
- Center for Cardiovascular and Pulmonary Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States.
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6
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Bender SB, Jia G, Sowers JR. Mineralocorticoid receptors: an appealing target to treat coronary microvascular dysfunction in diabetes. Diabetes 2015; 64:3-5. [PMID: 25538279 PMCID: PMC4274807 DOI: 10.2337/db14-1425] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Shawn B Bender
- Research, Harry S. Truman Memorial Veterans Hospital, Columbia, MO Department of Biomedical Sciences, University of Missouri, Columbia, MO Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO
| | - Guanghong Jia
- Research, Harry S. Truman Memorial Veterans Hospital, Columbia, MO Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Missouri School of Medicine, Columbia, MO
| | - James R Sowers
- Research, Harry S. Truman Memorial Veterans Hospital, Columbia, MO Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Missouri School of Medicine, Columbia, MO Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, MO
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