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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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Grover C, Jakhar D, Mishra A, Singal A. Nail-fold capillaroscopy for the dermatologists. Indian J Dermatol Venereol Leprol 2021; 88:300-312. [PMID: 34877857 DOI: 10.25259/ijdvl_514_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 03/01/2021] [Indexed: 11/04/2022]
Abstract
Nail fold is one of the most accessible sites for studying changes in the microcirculation in various microangiopathies. The characterization of changes in microvasculature can provide useful clues towards the diagnosis and prognosis of a disease. The diagnostic utility of nail fold capillaroscopy has improved and expanded over the past couple of decades. Beyond connective tissue diseases, it is now explored for its role in various systemic and dermatological diseases. Incorporation of nail-fold capillaroscopy in the diagnostic criteria of systemic sclerosis has generated interest among dermatologists. The current review is aimed at providing knowledge about nail-fold capillaroscopy to dermatologists. For the purpose of review, a PubMed search was done using the keywords "nail fold capillaries" and "nail fold capillaroscopy". All the articles were retrieved and classified into reviews and clinical studies of various types. The final data were then analyzed and presented in a narrative fashion.
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Affiliation(s)
- Chander Grover
- Department of Dermatology and STD, University College of Medical College and GTB Hospital, New Delhi, India
| | - Deepak Jakhar
- Department of Dermatology, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
| | - Arzoo Mishra
- Department of Dermatology and STD, University College of Medical College and GTB Hospital, New Delhi, India
| | - Archana Singal
- Department of Dermatology and STD, University College of Medical College and GTB Hospital, New Delhi, India
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Evaluation of demodicosis, nailfold capillaroscopy, and oxidative stress in rosacea: a case-control study. Postepy Dermatol Alergol 2021; 38:590-596. [PMID: 34658699 PMCID: PMC8501418 DOI: 10.5114/ada.2021.108917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 03/03/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction Inflammation, immune system disorders, Demodex infestation, neurovascular dysregulation and oxidative stress are thought to be contributory factors in the pathogenesis of rosacea. Aim To evaluate the presence of Demodex mites, the morphologic features of the nailfold capillaries, and the systemic oxidative stress status in patients with rosacea. Material and methods Thirty-one patients diagnosed with rosacea and 37 healthy age- and gender-matched subjects were included in this prospective case-control study. The presence of Demodex infestation, the findings of nailfold capillaroscopy (NFC), and the status of systemic oxidative stress measured by total oxidant capacity (TOC), total antioxidant capacity (TAC) and oxidative stress index (OSI) were evaluated. Results Demodex infestation rates were significantly higher in rosacea patients than in controls (p = 0.001). Increases in the diameters of the capillaries and the presence of avascular areas and crossing and abnormal structures were significantly more common in rosacea patients than in the healthy controls (p < 0.01, p = 0.016, p = 0.02, p < 0.001, respectively), and hairpin structures were significantly less common in rosacea patients than in the controls (p < 0.001). The presence of crossing capillaries was positively correlated with higher TOC levels (p = 0.05), while abnormal structures were found to be correlated with lower levels of TAC (p = 0.045). Conclusions Oxidative status and NFC may play diagnostic and prognostic roles in rosacea, which should be confirmed by studies with larger sample sizes.
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Junqueira CLC, Ferreira E, Junqueira ASM, de Almeida Cyrino FZG, Maranhão PA, Kraemer-Aguiar LG, Bottino DA, Coelho de Souza MDG, Bouskela E. Peripheral microvascular dysfunction is also present in patients with ischemia and no obstructive coronary artery disease (INOCA). Clin Hemorheol Microcirc 2021; 79:381-393. [PMID: 34151847 DOI: 10.3233/ch-201065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In patients with ischemia and no obstructive coronary artery disease (INOCA), coronary microvascular dysfunction is associated with higher rate of major adverse cardiovascular events. OBJECTIVE To demonstrate if microvascular dysfunction present in coronary microcirculation of patients with INOCA may be detected noninvasively in their peripheral circulation. METHODS 25 patients with INOCA and 25 apparently healthy individuals (controls) were subjected to nailfold videocapillaroscopy (NVC) and venous occlusion plethysmography (VOP) to evaluate peripheral microvascular function and blood collection for biomarkers analysis, including soluble vascular cell adhesion molecule-1 (sVCAM-1), endothelin-1 (ET-1) and C-reactive protein (CRP). RESULTS Red blood cell velocity (RBCV) before and after ischemia (RBCVmax) were significantly lower in patients with INOCA (p = 0.0001). Time to reach maximal red blood cell velocity (TRBCVmax) was significantly longer in INOCA group (p = 0.0004). Concerning VOP, maximal blood flow (p = 0.004) and its relative increment were significantly lower in patients with INOCA (p = 0.0004). RBCVmax showed significant correlations with sVCAM-1 (r = -0.38, p < 0.05), ET-1 (r = -0.73, p < 0.05) and CRP (r = -0.33, p < 0.05). Relative increment of maximal post-ischemic blood flow was significantly correlated with sVCAM-1 (r = -0.42, p < 0.05) and ET-1 (r = -0.48, p < 0.05). CONCLUSIONS The impairment of microvascular function present in coronary microcirculation of patients with INOCA can be also detected in peripheral microcirculation.
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Affiliation(s)
- Camillo L C Junqueira
- Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Esmeralci Ferreira
- Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.,Departamento de Cardiologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (UERJ), Brazil
| | | | | | - Priscila Alves Maranhão
- Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.,Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Luiz Guilherme Kraemer-Aguiar
- Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.,Departamento de Medicina Interna, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (UERJ), Brazil
| | - Daniel Alexandre Bottino
- Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Maria das Graças Coelho de Souza
- Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Eliete Bouskela
- Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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Characterization of microvascular disease in pediatric sickle cell disease using nailfold capillaroscopy. Microvasc Res 2021; 136:104150. [PMID: 33647341 DOI: 10.1016/j.mvr.2021.104150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 11/22/2022]
Abstract
Sickle cell disease (SCD) is a disorder with repetitive vaso-occlusive crises resulting in microvascular obstruction and tissue ischemia that may lead to multi-organ ischemia and dysfunction. Nailfold videocapillaroscopy (NFC) is an imaging technique utilized in clinical rheumatology to visualize capillaries located near the fingertip. To characterize NFC abnormalities in the setting of pediatric SCD, we performed NFC using a video capillaroscope on 8 digits in 44 stable SCD patients and 65 age matched healthy controls. Mean capillary number was lower (6.4 ± 1.3 vs 7.5 ± 1.8, p = 0.001) in the SCD group compared to controls. The percentage of dilated capillaries was similar (7.1 ± 8.3 vs. 5.9 ± 8.2, p = 0.4). The large majority of capillaries visualized in the SCD and control groups were normal capillary types per the EULAR definition, with a similar percentage of normal, nonspecific capillary morphologies and abnormal types. Regarding normal capillary sub-types, the SCD group and controls exhibited similar percentages of stereotype hairpin shapes, and tortuous or once or twice crossing type capillaries. On multivariate analyses, mean capillary number was independently associated with SCD after adjusting for age, body mass index, systolic blood pressure and gender. In conclusion, pediatric SCD is associated with lower capillary number but similar percentage of dilated capillaries and morphology on NFC. In our SCD cohort, capillary number was unrelated to our available markers of disease severity, including history of sickle crises, previous hospitalization for crises or Hemoglobin F levels.
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Characterization of microvascular disease in patients with sickle cell disease using nailfold capillaroscopy. Microvasc Res 2019; 125:103877. [DOI: 10.1016/j.mvr.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 03/21/2019] [Accepted: 04/28/2019] [Indexed: 11/21/2022]
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7
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Sanchez-Garcia ME, Ramirez-Lara I, Gomez-Delgado F, Yubero-Serrano EM, Leon-Acuña A, Marin C, Alcala-Diaz JF, Camargo A, Lopez-Moreno J, Perez-Martinez P, Tinahones FJ, Ordovas JM, Caballero J, Blanco-Molina A, Lopez-Miranda J, Delgado-Lista J. Evaluación cuantitativa de los cambios microvasculares capilaroscópicos en pacientes con cardiopatía isquémica establecida. Med Clin (Barc) 2018; 150:131-137. [DOI: 10.1016/j.medcli.2017.06.068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/23/2017] [Accepted: 06/08/2017] [Indexed: 11/28/2022]
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Bastos da Cunha C, Sicuro F, Maranhão PA, Borges MA, Cyrino FZ, Gazolla FM, Madeira IR, Bordallo MAN, Bouskela E, Kraemer-Aguiar LG. Microcirculation, Adiposity, and Traditional and Emerging Cardiovascular Risk Factors in Prepubertal Children. J Endocr Soc 2017; 1:908-917. [PMID: 29264541 PMCID: PMC5686770 DOI: 10.1210/js.2017-00130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/06/2017] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Previous studies have shown that microvascular dysfunction (MD) is associated with a number of cardiovascular risk factors, including obesity. Few studies have assessed microvascular reactivity in children, and in most of these, results were confounded by the effects of puberty. Our aim was to establish whether MD is already present in obese prepubertal children. METHODS This cross-sectional study included 52 obese, 18 overweight, and 28 eutrophic children, with a mean ± standard deviation age of 7.44 ± 1.22 years. We evaluated cardiovascular risk factors and nutritive microvascular function by using nailfold dynamic videocapillaroscopy and determined functional capillary density (FCD), red blood cell velocity at resting conditions (RBCV) and at peak (RBCVmax), and time to reach peak velocity during the post-occlusive reactive hyperemic response following 1 minute ischemia. RESULTS On univariate analysis, differences in microvascular reactivity were not observed among the groups. Obese and overweight children had significantly higher scores than eutrophic children for the following parameters: body mass index, waist circumference, waist-to-height ratio, mean arterial pressure, homeostasis model assessment for insulin resistance, levels of insulin, leptin, glucose, triglycerides, total cholesterol, uric acid, and C-reactive protein. Multivariate analysis demonstrated the association between metabolic, anthropometric, and microvascular variables, stratified according to the degree of adiposity and body fat distribution. CONCLUSIONS Univariate analysis did not show any difference in microvascular reactivity between groups but, by testing these variables by multivariate means, we noticed a common and direct variation between cardiovascular/metabolic risk factors and microvascular reactivity occurring early in life.
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Affiliation(s)
- Carolina Bastos da Cunha
- Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio Janeiro, Rio de Janeiro, Brazil 20550-170
| | - Fernando Sicuro
- Clinical and Experimental Research Laboratory on Vascular Biology (BioVasc), Biomedical Center, State University of Rio de Janeiro, Rio de Janeiro, Brazil 20550-013
| | - Priscila Alves Maranhão
- Department of Information Sciences and Health Decision (CIDES) of the Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Marcos Antonio Borges
- Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio Janeiro, Rio de Janeiro, Brazil 20550-170
| | - Fátima Z. Cyrino
- Clinical and Experimental Research Laboratory on Vascular Biology (BioVasc), Biomedical Center, State University of Rio de Janeiro, Rio de Janeiro, Brazil 20550-013
| | - Fernanda Mussi Gazolla
- Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio Janeiro, Rio de Janeiro, Brazil 20550-170
| | - Isabel Rey Madeira
- Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio Janeiro, Rio de Janeiro, Brazil 20550-170
| | - Maria Alice Neves Bordallo
- Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio Janeiro, Rio de Janeiro, Brazil 20550-170
| | - Eliete Bouskela
- Clinical and Experimental Research Laboratory on Vascular Biology (BioVasc), Biomedical Center, State University of Rio de Janeiro, Rio de Janeiro, Brazil 20550-013
| | - Luiz Guilherme Kraemer-Aguiar
- Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio Janeiro, Rio de Janeiro, Brazil 20550-170
- Clinical and Experimental Research Laboratory on Vascular Biology (BioVasc), Biomedical Center, State University of Rio de Janeiro, Rio de Janeiro, Brazil 20550-013
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Faccini A, Kaski JC, Camici PG. Coronary microvascular dysfunction in chronic inflammatory rheumatoid diseases. Eur Heart J 2016; 37:1799-806. [DOI: 10.1093/eurheartj/ehw018] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 01/19/2016] [Indexed: 12/11/2022] Open
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Wang Y, Zhang Y, Ma C, Guan Z, Liu S, Zhang W, Li Y, Yang J. Evaluation of Left and Right Atrial Function in Patients with Coronary Slow-Flow Phenomenon Using Two-Dimensional Speckle Tracking Echocardiography. Echocardiography 2016; 33:871-80. [PMID: 26857684 DOI: 10.1111/echo.13197] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Coronary slow-flow phenomenon (CSFP) is an angiographic diagnosis characterized by delayed coronary opacification in the absence of obstructive coronary artery disease. Currently, several investigators are focusing on ventricular function assessment in patients with CSFP; however, there is a paucity of data on their atrial function. This study was performed to evaluate left atrial (LA) and right atrial (RA) function in patients with CSFP. MATERIALS AND METHODS Eighty-two patients with CSFP and 55 controls without CSFP were enrolled in the study. Diagnosis of CSFP was made by thrombolysis in myocardial infarction frame count (TFC). The LA and RA global longitudinal strain and strain rate during systole (Ss, SRs), during early diastole (Se, SRe), and during late diastole (Sa, SRa) were measured using two-dimensional speckle tracking echocardiography. RESULTS In the CSFP group, LA Se and SRe decreased, while LA Sa and SRa increased, compared with the control group. RA Se and SRe were lower in patients with CSFP than in the controls. CONCLUSIONS LA conduit function decreased in patients with CSFP, while contractile function increased. RA conduit function also decreased in patients with CSFP.
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Affiliation(s)
- Yonghuai Wang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yan Zhang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China.,Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhengyu Guan
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shuang Liu
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Weixin Zhang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yuling Li
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, China
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Wang Y, Ma C, Zhang Y, Guan Z, Liu S, Li Y, Yang J. Assessment of left and right ventricular diastolic and systolic functions using two-dimensional speckle-tracking echocardiography in patients with coronary slow-flow phenomenon. PLoS One 2015; 10:e0117979. [PMID: 25706989 PMCID: PMC4338029 DOI: 10.1371/journal.pone.0117979] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 01/03/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Coronary slow-flow phenomenon (CSFP) is an angiographic diagnosis characterised by a low rate of flow of contrast agent in the normal or near-normal epicardial coronary arteries. Many of the patients with CSFP may experience recurrent acute coronary syndromes. However, current clinical practice tends to underestimate the impact of CSFP due to the yet unknown effect on the cardiac function. This study was performed to evaluate left ventricular (LV) and right ventricular (RV) diastolic and systolic functions, using two-dimensional (2D) longitudinal strain and strain rate, in patients with CSFP, and to determine the relationships between the thrombolysis in myocardial infarction (TIMI) frame count (TFC) and LV and RV diastolic and systolic functions. METHODS Sixty-three patients with CSFP and 45 age- and sex-matched controls without CSFP were enrolled in the study. Diagnosis of CSFP was made by TFC. LV and RV diastolic and systolic functions were assessed by 2D speckle-tracking echocardiography. RESULTS LV peak early diastolic longitudinal strain rate (LSRe) was lower in patients with CSFP than in controls (P = 0.01). LV peak systolic longitudinal strain (LS) and LV peak systolic longitudinal strain rate (LSRs) were lower in patients with CSFP than in controls (P = 0.004 and P = 0.03, respectively). There was no difference in LV ejection fraction. RV peak early diastolic longitudinal strain rate (RSRe) was lower in patients with CSFP than in controls (P = 0.03). There were no differences in RV peak systolic longitudinal strain (RS), RV peak systolic longitudinal strain rate (RSRs), or RV fractional area change among the groups. The mean TFC correlated negatively with LSRe and RSRe in patients with CSFP (r = -0.26, P = 0.04 and r = -0.32, P = 0.01, respectively). CONCLUSIONS LV diastolic and systolic functions were impaired in patients with CSFP. CSFP also affected RV diastolic function, but not RV systolic function.
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Affiliation(s)
- Yonghuai Wang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
- * E-mail:
| | - Yan Zhang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Zhengyu Guan
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Shuang Liu
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Yuling Li
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, Liaoning, People’s Republic of China
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Abstract
Nail abnormalities can arise in conjunction with or as a result of systematic pathologies. These pathologies include single-organ diseases, multisystemic diseases, and drug-induced insults. Clinical signs associated with these conditions include dyschromias, vascular alterations, periungual tissue changes, textural dystrophies, contour alterations, and growth-rate alterations. The associated systemic pathologies may affect any part of the nail apparatus, including the nail matrix, the nail plate, the nail bed, the underlying vasculature, and the periungual tissues. The anatomical location and extent of damage determine the clinically manifested anomaly.
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13
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Yamakoshi Y, Kotani K, Taniguchi N, Miwa T. Characterization of skin dermis microcirculation in flow-mediated dilation using optical sensor with pressurization mechanism. Med Biol Eng Comput 2013; 51:497-505. [PMID: 23274949 DOI: 10.1007/s11517-012-1017-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 12/17/2012] [Indexed: 11/24/2022]
Abstract
Blood flows out of microvessels in the dermis when pressure higher than arterial blood pressure is applied to the fingertip, and subsequently re-flows into the microcirculation when pressure is released. Both the blood outflow and the reflow characteristics of microcirculation under pressurization are associated with microvasculature, blood and blood pressure. This study describes a novel method of measuring blood inflow and outflow characteristics of dermis microcirculation. An optical sensor, which is furnished with a 571 nm wavelength light source and a photodetector, is pressed to the skin surface using a pressure higher than the human subject's systolic arterial pressure. Hemoglobin concentration by change of the blood flow amount is estimated by the Beer-Lambert law. This method is applied to the measurement of blood inflow and outflow characteristics of microcirculation caused by reactive hyperemia after ischemia with duration of 5 min. Among three parameters evaluated, the one relating to the amplitude of pulsation shows a close correlation with conventional plethysmography, while the other two show varying time responses. Our method provides a new and useful insight into pathophysiology in health and disease conditions and may help researchers better understand the underlying mechanisms of numerous microcirculation-influenced diseases and medical conditions.
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Affiliation(s)
- Yoshiki Yamakoshi
- Faculty of Engineering, Gunma University, 1-5-1 Tenjincho, Kiryu 376-8515, Japan.
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Emanuela F, Grazia M, Marco DR, Maria Paola L, Giorgio F, Marco B. Inflammation as a Link between Obesity and Metabolic Syndrome. J Nutr Metab 2012; 2012:476380. [PMID: 22523672 PMCID: PMC3317136 DOI: 10.1155/2012/476380] [Citation(s) in RCA: 186] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 10/19/2011] [Accepted: 11/03/2011] [Indexed: 12/14/2022] Open
Abstract
The metabolic syndrome is a complex of clinical features leading to an increased risk for cardiovascular disease and type 2 diabetes mellitus in both sexes. Visceral obesity and insulin resistance are considered the main features determining the negative cardiovascular profile in metabolic syndrome. The aim of this paper is to highlight the central role of obesity in the development of a chronic low-grade inflammatory state that leads to insulin resistance, endothelial and microvascular dysfunctions. It is thought that the starting signal of this inflammation is overfeeding and the pathway origins in all the metabolic cells; the subsequent increase in cytokine production recruits immune cells in the extracellular environment inducing an overall systemic inflammation. This paper focuses on the molecular and cellular inflammatory mechanisms studied until now.
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Affiliation(s)
- Faloia Emanuela
- Division of Endocrinology, Polytechnic University of Marche, via Conca 71, 60126 Ancona, Italy
| | - Michetti Grazia
- Division of Endocrinology, Polytechnic University of Marche, via Conca 71, 60126 Ancona, Italy
| | - De Robertis Marco
- Division of Endocrinology, Polytechnic University of Marche, via Conca 71, 60126 Ancona, Italy
| | - Luconi Maria Paola
- Division of Endocrinology, Polytechnic University of Marche, via Conca 71, 60126 Ancona, Italy
| | - Furlani Giorgio
- Division of Endocrinology, Polytechnic University of Marche, via Conca 71, 60126 Ancona, Italy
| | - Boscaro Marco
- Division of Endocrinology, Polytechnic University of Marche, via Conca 71, 60126 Ancona, Italy
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Naidu OA, Rajasekhar D, Latheef SAA. Assessment of endothelial function by brachial artery flow mediated dilatation in microvascular disease. Cardiovasc Ultrasound 2011; 9:40. [PMID: 22151947 PMCID: PMC3250931 DOI: 10.1186/1476-7120-9-40] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 12/09/2011] [Indexed: 11/15/2022] Open
Abstract
Background Cardiac syndrome X is an important therapeutic and diagnostic challenge to physician. Study of Csx patients may help to understand the pathophysiology of coronary microcirculation and to gain an insight on the management of these group patients. Methods We measured the flow mediated dilation of the brachial artery both endothelium dependent and independent vasodilatation by high resolution ultrasound in 30 cardiac syndrome X patients and matched with 30 healthy control subjects. Results Significantly decreased flow mediated dilatation was observed in patients when compared to control (9.42 ± 7.20 vs 21.11 ± 9.16 p < 0.01) but no significant difference was observed between groups in response to nitroglycerin (25.39 ± 6.82 vs 28.87 ± 8.69). Receiver operator characteristic analysis showed that value of < 11.11 had sensitivity of 80%, specificity 86.67%, positive predictive value 76.66%, negative predictive value 83.33%. In total, 46% of subjects had endothelial dysfunction and of them, CSX subjects had higher prevalence (76% vs 16% p < 0.01) than control subjects. Higher mean values of body mass index, systolic blood pressure and diastolic blood pressure was observed in subjects with FMD < 11.11 than > 11.11(p < 0.01). In logistic regression analysis, FMD was significantly associated with systolic blood pressure (Odds ratio 1.122 95% CI 1.053-1.196 p < 0.01) and body mass index (Odds 1.248 95%CI 0.995-1.56 p < 0.05). Conclusions The study suggests impairment of endothelial function in cardiac syndrome X patients. Increased Systolic blood pressure and body mass index may increase the risk of impairment of endothelial function in this group of patients.
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Affiliation(s)
- Otikunta Adikesava Naidu
- Department of Cardiology, Osmania General Hospital and Osmania Medical College, Hyderabad, Andhra Pradesh, India.
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Uchida Y, Kanai M, Maezawa Y, Maezawa Y, Shirai S, Nakagawa O, Uchida Y. Cardioscopic observation of subendocardial microvessels in patients with coronary artery disease. Int Heart J 2011; 52:274-9. [PMID: 22008435 DOI: 10.1536/ihj.52.274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Coronary microvessels play a direct and critical role in determining the extent and severity of myocardial ischemia and cardiac function. However, because direct observation has never been performed in vivo, the functional properties of the individual microvesssels in patients with coronary artery disease remain unknown. Subendocardial coronary microvessels were observed by cardioscopy in 149 successive patients with coronary artery disease (81 with stable angina and 68 with old myocardial infarction). Twenty-four arterial microvessels (AMs) and 27 venous microvessels (VMs) were observed in the left ventricular subendocardium. All 12 AMs and 13 of 14 VMs that were located in normokinetic-to-hypokinetic left ventricular wall segments were filled with blood during diastole and were collapsed during systole. In contrast, 8 of 12 AMs and 9 of 13 VMs that were located in akinetic-to-dyskinetic wall segments were filled with blood during systole and were collapsed during diastole. There were no significant correlations between the timing of blood filling and the severity of coronary stenosis and collateral development. In patients with coronary artery disease, the timing of blood filling of AMs and VMs was dependent on the regional left ventricular contractile state; during diastole when contraction was preserved and during systole when it was not. It remains to be elucidated whether and how blood filling is disturbed in other categories of heart disease.
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Affiliation(s)
- Yasuto Uchida
- Department of Cardiology, Toho University Medical Center Ohmori Hospital, Tokyo, Japan
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17
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Abstract
Percutaneous cardioscopy, using high-resolution fiberoptic imaging, enables direct visualization of the cardiac interior, thereby enabling macroscopic pathological diagnosis. Percutaneous cardioscopy has demonstrated that the endocardial surface exhibits various colors characteristic of different heart diseases. This imaging modality can now be used for evaluation of the severity of myocardial ischemia, and staging of myocarditis. Myocardial blood flow recovery induced by vasodilating agents or percutaneous coronary interventions can be clearly visualized. Morphological and functional changes in the cardiac valves can also be evaluated. Cardioscope-guided endomyocardial biopsy enables pin-point biopsy of the diseased myocardium. Recently, dye-image cardioscopy and fluorescence cardioscopy were developed for evaluation of the subendocardial microcirculation. Cardioscope-guided intracardiac therapies such as myotomy, myectomy, valvulotomy, and transendocardial angiogenic and myogenic therapy have been trialed using animal models in anticipation of future clinical applications. Percutaneous cardioscopy has the potential to contribute to our understanding of heart disease, and to assist in guidance for intracardiac therapies.
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Affiliation(s)
- Yasumi Uchida
- Japan Foundation for Cardiovascular Research, 2-30-17, Narashinodai, Funabashi, 274-0063 Japan
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18
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Maranhão PA, Kraemer-Aguiar LG, de Oliveira CL, Kuschnir MCC, Vieira YR, Souza MGC, Koury JC, Bouskela E. Brazil nuts intake improves lipid profile, oxidative stress and microvascular function in obese adolescents: a randomized controlled trial. Nutr Metab (Lond) 2011; 8:32. [PMID: 21619692 PMCID: PMC3123174 DOI: 10.1186/1743-7075-8-32] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Accepted: 05/28/2011] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Obesity is a chronic disease associated to an inflammatory process resulting in oxidative stress that leads to morpho-functional microvascular damage that could be improved by some dietary interventions. In this study, the intake of Brazil nuts (Bertholletia excelsa), composed of bioactive substances like selenium, α- e γ- tocopherol, folate and polyunsaturated fatty acids, have been investigated on antioxidant capacity, lipid and metabolic profiles and nutritive skin microcirculation in obese adolescents. METHODS Obese female adolescents (n = 17), 15.4 ± 2.0 years and BMI of 35.6 ± 3.3 kg/m2, were randomized 1:1 in two groups with the diet supplemented either with Brazil nuts [BNG, n = 08, 15-25 g/day (equivalent to 3 to 5 units/day)] or placebo [PG (lactose), n = 09, one capsule/day] and followed for 16 weeks. Anthropometry, metabolic-lipid profiles, oxidative stress and morphological (capillary diameters) and functional [functional capillary density, red blood cell velocity (RBCV) at baseline and peak (RBCVmax) and time (TRBCVmax) to reach it during post-occlusive reactive hyperemia, after 1 min arterial occlusion] microvascular variables were assessed by nailfold videocapillaroscopy at baseline (T0) and after intervention (T1). RESULTS T0 characteristics were similar between groups. At T1, BNG (intra-group variation) had increased selenium levels (p = 0.02), RBCV (p = 0.03) and RBCVmax (p = 0.03) and reduced total (TC) (p = 0.02) and LDL-cholesterol (p = 0.02). Compared to PG, Brazil nuts intake reduced TC (p = 0.003), triglycerides (p = 0.05) and LDL-ox (p = 0.02) and increased RBCV (p = 0.03). CONCLUSION Brazil nuts intake improved the lipid profile and microvascular function in obese adolescents, possibly due to its high level of unsaturated fatty acids and bioactive substances. TRIAL REGISTRATION Clinical Trials.gov NCT00937599.
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Affiliation(s)
- Priscila A Maranhão
- Clinical and Experimental Research Laboratory in Vascular Biology - BioVasc; Rua São Francisco Xavier, 524, Rio de Janeiro, CEP:20550-013 - Brazil
| | - Luiz G Kraemer-Aguiar
- Endocrinology, Department of Internal Medicine; Clinical and Experimental Research Laboratory in Vascular Biology - BioVasc; Rua São Francisco Xavier, 524, Rio de Janeiro, CEP:20550-013 - Brazil
| | - Cecilia L de Oliveira
- Nutrition Applied Department; Nutrition Institute - Rua São Francisco Xavier, 524, Rio de Janeiro, CEP: 20550-013 - Brazil
| | - Maria CC Kuschnir
- Study Center for Adolescent Health - NESA Av 28 de setembro,. 87, CEP: 20551-030, Rio de Janeiro - Brazil
| | - Yasmine R Vieira
- Clinical and Experimental Research Laboratory in Vascular Biology - BioVasc; Rua São Francisco Xavier, 524, Rio de Janeiro, CEP:20550-013 - Brazil
| | - Maria GC Souza
- Physiological Sciences Department; Clinical and Experimental Research Laboratory in Vascular Biology - BioVasc; Rua São Francisco Xavier, 524 , Rio de Janeiro CEP:20550-013 - Brazil
| | - Josely C Koury
- Study Center for Nutrition and Oxidative Stress; Nutrition Institute; Rua São Francisco Xavier, 524, Rio de Janeiro, CEP: 20550-013 - Brazil
| | - Eliete Bouskela
- Physiological Sciences and Clinical Medicine Departments; Clinical and Experimental Research Laboratory in Vascular Biology - BioVasc; Rua São Francisco Xavier, 524 Rio de Janeiro, CEP:20550-013 -Brazil
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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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Abstract
Nailfold videocapillaroscopy (NVC) is one of the best diagnostic non-invasive imaging techniques to evaluate microcirculation in vivo and is increasingly employed in the field of rheumatology. Indeed, at present, the most important utility of NVC is in the identification of microvascular involvement in many rheumatic diseases, particularly in systemic sclerosis. More recently, this technique has been shown to be applicable to the study of many other extra-rheumatic diseases, such as arterial hypertension, diabetes mellitus, acromegaly, hyperthyroidism, cardiac syndrome X, primary biliary cirrhosis, Crohn's disease, psoriasis, familial Mediterranean fever. This article sets down the methodology of examination and normal pattern of capillary vessels and reviews the applications of NVC in clinical practice and its results in rheumatic and non-rheumatic diseases.
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Kraemer-Aguiar LG, Laflor CM, Bouskela E. Skin microcirculatory dysfunction is already present in normoglycemic subjects with metabolic syndrome. Metabolism 2008; 57:1740-6. [PMID: 19013299 DOI: 10.1016/j.metabol.2008.07.034] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 07/11/2008] [Indexed: 11/18/2022]
Abstract
The role of microcirculatory dysfunction (MD) in metabolic and cardiovascular diseases is not well established. Considering that metabolic syndrome (MS) is an independent risk factor and diabetic patients have microangiopathy, our aim was to investigate if normoglycemic subjects with MS already have detectable skin MD. Thirty-six subjects with MS (National Cholesterol Education Program-Adult Treatment Panel III criteria) (10 men/26 women, 38.8 +/- 7.9 years, 35.8 +/- 4.9 kg/m(2)) with normal glucose tolerance (American Diabetes Association criteria) and 16 controls (11 men/5 women, 33.6 +/- 8.4 years, 23.9 +/- 3.6 kg/m(2)) were studied using nailfold videocapillaroscopy. Afferent, efferent, and apical capillary diameters; functional capillary density; red blood cell velocity (RBCV) at baseline; and RBCV(max) and time (TRBCV(max)) to reach it during postocclusive reactive hyperemia after 1-minute arterial occlusion were measured. Subjects with MS had smaller afferent, efferent, and apical diameters (4.2 [3.8-4.2] vs 5.6 [4.65-6.25] mum, P < .001; 4.8 [4.2-4.8] vs 6.2 [5.6-7] mum, P < .001; and 5.2 [4.8-5.55] vs 7.4 [6.2-8] mum, P < .001); lower functional capillary density (7.28 [6.37-9.10] vs 10.4 [9.1-11.8] capillaries per square millimeter, P < .001), RBCV (0.62 [0.57-0.65] vs 0.79 [0.76-0.89] mm/s, P < .001], and RBCV(max) (1.14 [1.12-1.210] vs 1.57 [1.45-1.62] mm/s, P < .001); and longer TRBCV(max) (10.0 [10-11] vs 4.5 [4-6] seconds, P < .001) compared with controls. Microcirculatory dysfunction was associated with body mass index. We concluded that subjects with MS already have nutritive skin MD even within the normoglycemic milieu.
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Affiliation(s)
- Luiz Guilherme Kraemer-Aguiar
- Laboratório de Pesquisas em Microcirculação, Biomedical Center, State University of Rio de Janeiro, Rio de Janeiro 20550-013, Brazil
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Contribution of abnormal arterial function to cardiac syndrome X: a study of pressure waveform analysis and exercise haemodynamics. J Hum Hypertens 2007; 22:217-9. [PMID: 17928877 DOI: 10.1038/sj.jhh.1002294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ritchie SA, Connell JMC. The link between abdominal obesity, metabolic syndrome and cardiovascular disease. Nutr Metab Cardiovasc Dis 2007; 17:319-326. [PMID: 17110092 DOI: 10.1016/j.numecd.2006.07.005] [Citation(s) in RCA: 441] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Revised: 07/12/2006] [Accepted: 07/13/2006] [Indexed: 02/06/2023]
Abstract
AIM The prevalence of metabolic syndrome has increased dramatically in recent years, and the cluster of metabolic abnormalities it encompasses results in increased cardiovascular morbidity and mortality. The role of abdominal (visceral) obesity and the underlying molecular and cellular mechanisms central to this association have been the subject of intensive research in recent times. The aim of this review is to correlate data in this area, highlighting the central role of excess visceral fat and its secreted adipokines, and to review existing and emerging therapies. DATA SYNTHESIS Data were generated from a search of the PubMed database using the terms 'abdominal obesity', 'metabolic syndrome', 'insulin resistance', 'adipokines', 'interleukin-6 (IL-6)', 'adiponectin', 'tumour necrosis factor-alpha (TNF-alpha)' and 'cardiovascular disease'. CONCLUSION Metabolic syndrome is associated with a pro-inflammatory state, and the role of visceral obesity is thought to be central to this. Visceral obesity leads to alteration of the normal physiological balance of adipokines, insulin resistance, endothelial dysfunction and a pro-atherogenic state. In association with this, the presence of conventional cardiovascular risk factors such as hypertension, dyslipidaemia and smoking results in a significantly elevated cardiovascular and metabolic (cardiometabolic) risk. Better understanding of the molecular mechanisms central to this association has led to the development of potential therapeutic agents.
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Affiliation(s)
- S A Ritchie
- BHF Cardiovascular Research Centre, Glasgow University, 26 University Place, Glasgow G12 8TA, UK.
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Nabipour I, Amiri M, Imami SR, Jahfari SM, Shafeiae E, Nosrati A, Iranpour D, Soltanian AR. The metabolic syndrome and nonfatal ischemic heart disease; a population-based study. Int J Cardiol 2006; 118:48-53. [PMID: 16875744 DOI: 10.1016/j.ijcard.2006.06.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 06/04/2006] [Accepted: 06/18/2006] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Metabolic syndrome comprises insulin resistance, abdominal fat distribution, dyslipidemia and hypertension. The metabolic syndrome is expected to be diagnosed in millions of subjects in the near future worldwide. There are very few data in literature clearly documenting that subjects with metabolic syndrome have an increased cardiovascular risk. DESIGN Cross-sectional, population-based study. MATERIALS AND METHODS We used National Cholesterol Education Program (NCEP)-Adult Treatment Panel (ATP)-III criteria and Minnesota Code of a 12-lead resting electrocardiogram (EKG) to assess the association of metabolic syndrome and nonfatal ischemic heart disease in 3723 subjects, aged 25 years and over, selected by cluster random sampling in three Iranian ports in the northern Persian Gulf. Electrocardiogram with evidence of IHD (IHD EKG) was defined as myocardial infarction (codes 1.1 and 1.2) and ischemia (codes 1.3, 4.1-4.4, 5.1-5.3 and 7.1) together. RESULTS An estimated 49.08% (52.04% of males and 46.34% of females) were identified as fulfilling NCEP-ATP III criteria for diagnosing the metabolic syndrome. Prevalence of EKG with evidence of ischemic heart disease (IHD EKG) was 12.7% (10.4% for men and 14.7% for women, p<0.0001). In multiple logistic regression analysis, metabolic syndrome was found to have a significant association with IHD EKG [OR=1.35, CI (1.09-1.66), p=0.005] after adjusting for sex and age. Of the metabolic syndrome components, elevated blood sugar (OR=2.69, p<0.001), high blood pressure (OR=1.79, p=0.001) and low HDL-C (OR=1.27, p=0.02) had significant independent association with IHD EKG. CONCLUSION The metabolic syndrome, which occurs very frequently in the general population, has a significant association with nonfatal ischemic heart disease by electrocardiogram criteria.
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Affiliation(s)
- Iraj Nabipour
- Department of Internal Medicine, School of Medicine, Bushehr University of Medical Science, Bushehr, I.R. Iran.
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Jadhav ST, Ferrell WR, Petrie JR, Scherbakova O, Greer IA, Cobbe SM, Sattar N. Microvascular function, metabolic syndrome, and novel risk factor status in women with cardiac syndrome X. Am J Cardiol 2006; 97:1727-31. [PMID: 16765122 DOI: 10.1016/j.amjcard.2005.12.069] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Revised: 12/22/2005] [Accepted: 12/22/2005] [Indexed: 11/15/2022]
Abstract
To characterize microvascular function, candidate risk pathways, and metabolic syndrome prevalence in women with cardiac syndrome X, 52 nondiabetic women with angiographically normal epicardial arteries but >1 mm of planar ST depression during exercise testing (patients) and 24 healthy controls of similar age were recruited. In addition to fasting blood samples and anthropometric measurements, forearm cutaneous microvascular function after iontophoresis of acetylcholine and sodium nitroprusside was assessed by laser Doppler imaging. Despite body mass index correction and a larger proportion on statin therapy, patients had high levels of insulin (p=0.016), triglycerides (p=0.018), intercellular adhesion molecule-1 (p=0.021), von Willebrand factor (p=0.005), and leptin (p=0.005) and lower levels of high-density lipoprotein cholesterol (p=0.042) compared with controls. Consistent with these data, 30% of patients but only 8% of controls fulfilled criteria for the metabolic syndrome as defined by the National Cholesterol Education Program (p=0.015). Endothelium-dependent and -independent microvascular functions were markedly impaired in patients (p<0.001), and the odds ratio for cardiac syndrome X was 7.38 (95% confidence interval 2.2 to 24.7) if the acetylcholine response was <8,710 flux units. In conclusion, women with cardiac syndrome X more commonly have metabolic syndrome and related adiposity, metabolic, and inflammatory derangements. They also have significantly impaired skin microvascular function as assessed by laser Doppler imaging, consistent with generalized vascular dysfunction, a finding with potential diagnostic implications.
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Affiliation(s)
- Sachin T Jadhav
- The Glasgow Royal Infirmary, Glasgow, Scotland, United Kingdom.
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Yigit F, Sezgin AT, Demircan S, Tekin G, Erol T, Muderrisoglu H. Slow Coronary Flow is Associated with Carotid Artery Dilatation. TOHOKU J EXP MED 2006; 209:41-8. [PMID: 16636521 DOI: 10.1620/tjem.209.41] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Slow coronary flow (SCF) in a normal coronary angiogram is a well-recognized clinical entity, but its etiopathogenesis remains unclear. Carotid intima-media thickness (CIMT) is a noninvasive marker of atherosclerosis. The aim of this study was to investigate the CIMT and diameter of carotid and coronary artery in relation to SCF. Twenty-four patients with angiographically diagnosed SCF (51 +/- 7 years), and 26 age-matched subjects with normal coronary flow (NCF) (52 +/- 8 years) in the coronary angiography were enrolled. Coronary flow rates were documented by thrombolysis in myocardial infarction (TIMI) frame count (TFC), a simple method for evaluating coronary blood flow. Carotid and coronary artery diameters and CIMT were measured. Mean TFC was significantly higher in patients with SCF than in patients with NCF (p < 0.001). There were no significant differences regarding maximum (p = 0.84) and mean CIMT (p = 0.61). On the other hand, carotid lumen (p = 0.03) and coronary artery diameters (p = 0.001) were significantly greater in patients with SCF than in subjects with NCF. There was a significant relation between mean coronary artery diameter and TFC (p = 0.004, 95% CI for OR: 1.61-11.87). In conclusion, these findings suggest that CIMT is not altered in patients with SCF as compared with those with NCF. However, carotid and coronary artery diameters are increased in patients with SCF as compared to those with NCF. Because the common carotid artery can be assessed in nearly every patient, carotid artery dilatation may be used as an early indicator for SCF.
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Affiliation(s)
- Fatma Yigit
- Department of Cardiology, Baskent University School of Medicine, Dadaloglu Mah, Serinevler 39/6, 01250-Yuregir, Adana, Turkey.
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Karacalioglu AO, Demirkol S, Emer O, Celik T, Kilic S, Ilgan S, Ozguven MA. Scintigraphic Imaging of Endothelium-Dependent Vasodilation in the Forearm A Preliminary Report. Circ J 2006; 70:311-5. [PMID: 16501298 DOI: 10.1253/circj.70.311] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The diagnosis of endothelial dysfunction has been gaining clinical importance, but although endothelial function testing is available in the research setting, no technique yet exists that is simple, safe, reproducible and easily performed as a clinical screening method. The aim of this study was to design a new, scintigraphic method of imaging the flow-mediated dilation in the forearm, which represents the functional characteristic of endothelial dysfunction. METHODS AND RESULTS The study group comprised 118 subjects in whom left forearm ischemia was induced by inflating a sphygmomanometer cuff to supra systolic pressure for 4.5 min. Later, dynamic acquisition (2 s frame/min) was initiated after the injection of technetium-99m methoxy-isobutyl isonitril into the dorsal pedal veins. Equivalent regions of interest were drawn on both arms to detect total activity counts during 1 min and the perfusion ratios (left arm/right arm) were calculated. The left arm counts (22,203.3+/-12,372.7) were significantly higher than the right arm counts (9,980.9+/-5,931.9) (p<0.001). A significant decrease in perfusion ratios was noted in the hypertension and hypercholesterolemia groups. An increase in the number of risk factors caused an insignificant decrease in perfusion ratio (p=0.346). CONCLUSION Non-invasive evaluation of endothelium-dependent vasodilation by semiquantitative scintigraphic method using radioactive perfusion tracer provided promising results.
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Affiliation(s)
- Alper O Karacalioglu
- Department of Nuclear Medicine, Gulhane Military Medical Academy and School of Medicine, Etlik-Ankara, Turkey.
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