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Di Nardo G, Di Pippo M, Zenzeri L, Mennini M, Piccirillo M, Furio S, Quatrale G, Evangelisti M, Parisi P, Lucchini L, Ferretti A, Villa MP, Scuderi G, Amadè DS, Abdolrahimzadeh S. Ocular endothelial dysfunction in pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2024. [PMID: 38587115 DOI: 10.1002/jpn3.12208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/28/2024] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVES To assess ocular microvasculature changes using optical coherence tomography angiography (OCTA) in pediatric patients with inflammatory bowel disease (IBD). METHODS Patients (aged 6-18 years) with IBD were recruited between September 2021 and May 2023. All eligible participants underwent comprehensive clinical assessment and laboratory investigation. Patients with functional gastrointestinal disorders served as the controls. This study assessed specific IBD phenotypes, disease duration, clinical and endoscopic activity indices, laboratory markers, and medication histories. OCTA was utilized to evaluate ocular microvasculature changes in both groups. RESULTS A total of 63 children (mean age 12.9 ± 3.3 years) were enrolled, comprising 38 in the IBD group (16 ulcerative colitis, 22 Crohn's disease, and 25 in the control group). Most patients in the IBD group were in remission or had mild-to-moderate disease activity at enrollment. Analysis of the OCTA results revealed significant differences in the choroidal luminal area and total choroidal area between the IBD and control groups. CONCLUSIONS The study identified distinct ocular microvasculature changes in pediatric IBD patients through OCTA, suggestive of potential systemic endothelial dysfunction. These findings underscore the utility of OCTA in evaluating microvascular alterations associated with pediatric IBD, offering insights into potential systemic complications linked to inflammation in IBD patients.
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Affiliation(s)
- Giovanni Di Nardo
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Mariachiara Di Pippo
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Ophthalmology Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Letizia Zenzeri
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
- Emergency Pediatric Department, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Maurizio Mennini
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Marisa Piccirillo
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Silvia Furio
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Giovanna Quatrale
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Melania Evangelisti
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Pasquale Parisi
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Livia Lucchini
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Alessandro Ferretti
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Maria Pia Villa
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Pediatric Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Gianluca Scuderi
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Ophthalmology Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - David Sarzi Amadè
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Stomatology Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
| | - Solmaz Abdolrahimzadeh
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Ophthalmology Unit, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy
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Britzen-Laurent N, Weidinger C, Stürzl M. Contribution of Blood Vessel Activation, Remodeling and Barrier Function to Inflammatory Bowel Diseases. Int J Mol Sci 2023; 24:ijms24065517. [PMID: 36982601 PMCID: PMC10051397 DOI: 10.3390/ijms24065517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023] Open
Abstract
Inflammatory bowel diseases (IBDs) consist of a group of chronic inflammatory disorders with a complex etiology, which represent a clinical challenge due to their often therapy-refractory nature. In IBD, inflammation of the intestinal mucosa is characterized by strong and sustained leukocyte infiltration, resulting in the loss of epithelial barrier function and subsequent tissue destruction. This is accompanied by the activation and the massive remodeling of mucosal micro-vessels. The role of the gut vasculature in the induction and perpetuation of mucosal inflammation is receiving increasing recognition. While the vascular barrier is considered to offer protection against bacterial translocation and sepsis after the breakdown of the epithelial barrier, endothelium activation and angiogenesis are thought to promote inflammation. The present review examines the respective pathological contributions of the different phenotypical changes observed in the microvascular endothelium during IBD, and provides an overview of potential vessel-specific targeted therapy options for the treatment of IBD.
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Affiliation(s)
- Nathalie Britzen-Laurent
- Division of Surgical Research, Department of Surgery, Translational Research Center, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
- Correspondence:
| | - Carl Weidinger
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, 12203 Berlin, Germany
| | - Michael Stürzl
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
- Division of Molecular and Experimental Surgery, Translational Research Center, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
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Kul S, Caliskan Z, Guvenc TS, Celik FB, Sarmis A, Atici A, Konal O, Akıl M, Cumen AS, Bilgic NM, Yilmaz Y, Caliskan M. Gut microbiota-derived metabolite trimethylamine N-oxide and biomarkers of inflammation are linked to endothelial and coronary microvascular function in patients with inflammatory bowel disease. Microvasc Res 2023; 146:104458. [PMID: 36471530 DOI: 10.1016/j.mvr.2022.104458] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/31/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD), which is an umbrella term used for ulcerative colitis (UC) and Crohn's disease (CD), is associated with an increased risk for atherosclerotic cardiovascular disease (CVD). We aimed to investigate the association of local and systemic biomarkers of inflammation and gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) with endothelial and coronary microvascular dysfunction in IBD. METHODS A total of 56 patients with IBD (20 with UC and 36 with CD) and 34 age and gender matched controls were included. For all participants, samples were collected to analyze faecal calprotectin, and TMAO concentrations. Ultrasound-based examinations were done to measure flow-mediated vasodilatation (FMD) and coronary flow velocity reserve (CFVR). RESULTS Patients with IBD had lower CFVR (2.07 (1.82-2.40)) and FMD (8.7 ± 3.7) as compared to controls (2.30 (2.07-2.74), p = 0.005 and 11.9 ± 6.8, p = 0.03). In patients with IBD, TMAO concentration (r = -0.30, p = 0.03), C-reactive protein (r = -0.29, p = 0.03) and WBC count (r = -0.37, p = 0.006) had a significant negative correlation with CFVR, and TMAO (β = -0.27, 95 % CI: -0.23 to -0.02) and WBC count (β = -0.31, 95 % CI: -0.56 to -0.06) were significant predictors of CFVR after multivariate adjustment. None of the biomarkers of inflammation or TMAO showed significant correlations with FMD. In patients with UC, TMAO showed a significant correlation with both CFVR (r = -0.55, p = 0.01) and FMD (r = -0.60, p = 0.005) while only WBC count had a statistically significant correlation with CFVR (r = -0.49, p = 0.004) in patients with CD. CONCLUSIONS Gut microbiota-derived metabolite TMAO and biomarkers of systemic inflammation are associated with measures of endothelial/coronary microvascular dysfunction in patients with IBD.
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Affiliation(s)
- Seref Kul
- Cardiology Department, Istanbul Medeniyet University, Faculty of Medicine, Prof Dr Suleyman Yalcin City Hospital, Dr. Erkin street, 34722 Istanbul, Turkey
| | - Zuhal Caliskan
- Gastroenterology Department, Istanbul Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Tolga Sinan Guvenc
- Department of Cardiology, Istinye University Faculty of Medicine, Istanbul, Turkey
| | - Fatma Betul Celik
- Cardiology Department, Istanbul Medeniyet University, Faculty of Medicine, Prof Dr Suleyman Yalcin City Hospital, Dr. Erkin street, 34722 Istanbul, Turkey
| | - Abdurrahman Sarmis
- Department of Medical Microbiology Laboratory, Prof Dr Suleyman Yalcin City Hospital, Dr. Erkin street, 34722 Istanbul, Turkey
| | - Adem Atici
- Cardiology Department, Istanbul Medeniyet University, Faculty of Medicine, Prof Dr Suleyman Yalcin City Hospital, Dr. Erkin street, 34722 Istanbul, Turkey
| | - Oguz Konal
- Cardiology Department, Istanbul Medeniyet University, Faculty of Medicine, Prof Dr Suleyman Yalcin City Hospital, Dr. Erkin street, 34722 Istanbul, Turkey
| | - Mesut Akıl
- Department of Parasitology, Faculty of Medicine, Istanbul Medeniyet University, Prof Dr Suleyman Yalcin City Hospital, Dr. Erkin street, 34722 Istanbul, Turkey
| | - Ahmet Selin Cumen
- Cardiology Department, Istanbul Medeniyet University, Faculty of Medicine, Prof Dr Suleyman Yalcin City Hospital, Dr. Erkin street, 34722 Istanbul, Turkey
| | - Nermin Mutlu Bilgic
- Gastroenterology Department, Istanbul Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Yusuf Yilmaz
- Cardiology Department, Istanbul Medeniyet University, Faculty of Medicine, Prof Dr Suleyman Yalcin City Hospital, Dr. Erkin street, 34722 Istanbul, Turkey
| | - Mustafa Caliskan
- Cardiology Department, Istanbul Medeniyet University, Faculty of Medicine, Prof Dr Suleyman Yalcin City Hospital, Dr. Erkin street, 34722 Istanbul, Turkey.
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Kakuta K, Dohi K, Yamamoto T, Fujimoto N, Shimoyama T, Umegae S, Ito M. Coronary Microvascular Dysfunction Restored After Surgery in Inflammatory Bowel Disease: A Prospective Observational Study. J Am Heart Assoc 2021; 10:e019125. [PMID: 33899514 PMCID: PMC8200729 DOI: 10.1161/jaha.120.019125] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background We aimed to investigate the presence and severity of coronary microvascular dysfunction (CMD) in inflammatory bowel disease (IBD) including Crohn disease and ulcerative colitis and to elucidate the influence of surgical resection of the diseased intestines on CMD by assessing coronary flow velocity reserve (CFVR) using transthoracic Doppler echocardiography. Methods and Results Thirty‐seven patients with IBD (aged 44±15 years; 22 patients with Crohn disease and 15 patients with ulcerative colitis) and 30 controls (aged 46±12 years) were enrolled. For CFVR measurement, coronary flow velocity was recorded at rest and during hyperemia by ADP infusion using transthoracic Doppler echocardiography, and CFVR <2.5 defined CMD. CFVR measurement was repeated before and within 1 year after surgery. CFVR was similarly and significantly lower in patients with Crohn disease and those with ulcerative colitis than controls (Crohn disease: 2.92±1.03 [P<0.05 versus controls], ulcerative colitis: 2.99±0.65 [P<0.05 versus controls], and controls: 3.84±0.75). Multiple linear regression analysis showed that the presence of IBD and baseline hs‐CRP (high‐sensitivity C‐reactive protein) were independently associated with low CFVR among all study participants (β=−0.403 [P=0.001] and −0.237 [P=0.037], respectively). Hyperemic coronary flow velocity significantly improved after surgery only in patients with IBD who had CMD. CFVR significantly improved in patients with IBD who had both CMD and non‐CMD, and the extent of CFVR improvements were greater in patients with CMD than non‐CMD. Multiple linear regression analysis showed that the reduction of hs‐CRP was independently associated with improvement of hyperemic coronary flow velocity and CFVR among all patients with IBD (β=−0.481 [P=0.003] and β=−0.334 [P=0.043], respectively). Conclusions IBD is associated with CMD, which improved after surgical resection of diseased intestines.
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Affiliation(s)
- Kentaro Kakuta
- Department of Cardiology and Nephrology Mie University Graduate School of Medicine Tsu Japan.,Department of Cardiology Japan Community Health Care Organization Yokkaichi Hazu Medical Center Yokkaichi Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology Mie University Graduate School of Medicine Tsu Japan
| | - Takayuki Yamamoto
- Inflammatory Bowel Disease Center Japan Community Health care Organization Yokkaichi Hazu Medical Center Yokkaichi Japan
| | - Naoki Fujimoto
- Department of Cardiology and Nephrology Mie University Graduate School of Medicine Tsu Japan
| | - Takahiro Shimoyama
- Inflammatory Bowel Disease Center Japan Community Health care Organization Yokkaichi Hazu Medical Center Yokkaichi Japan
| | - Satoru Umegae
- Inflammatory Bowel Disease Center Japan Community Health care Organization Yokkaichi Hazu Medical Center Yokkaichi Japan
| | - Masaaki Ito
- Department of Cardiology and Nephrology Mie University Graduate School of Medicine Tsu Japan
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Jalali Z, Khademalhosseini M, Soltani N, Esmaeili Nadimi A. Smoking, alcohol and opioids effect on coronary microcirculation: an update overview. BMC Cardiovasc Disord 2021; 21:185. [PMID: 33858347 PMCID: PMC8051045 DOI: 10.1186/s12872-021-01990-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 04/07/2021] [Indexed: 02/07/2023] Open
Abstract
Smoking, heavy alcohol drinking and drug abuse are detrimental lifestyle factors leading to loss of million years of healthy life annually. One of the major health complications caused by these substances is the development of cardiovascular diseases (CVD), which accounts for a significant proportion of substance-induced death. Smoking and excessive alcohol consumption are related to the higher risk of acute myocardial infarction. Similarly, opioid addiction, as one of the most commonly used substances worldwide, is associated with cardiac events such as ischemia and myocardial infarction (MI). As supported by many studies, coronary artery disease (CAD) is considered as a major cause for substance-induced cardiac events. Nonetheless, over the last three decades, a growing body of evidence indicates that a significant proportion of substance-induced cardiac ischemia or MI cases, do not manifest any signs of CAD. In the absence of CAD, the coronary microvascular dysfunction is believed to be the main underlying reason for CVD. To date, comprehensive literature reviews have been published on the clinicopathology of CAD caused by smoking and opioids, as well as macrovascular pathological features of the alcoholic cardiomyopathy. However, to the best of our knowledge there is no review article about the impact of these substances on the coronary microvascular network. Therefore, the present review will focus on the current understanding of the pathophysiological alterations in the coronary microcirculation triggered by smoking, alcohol and opioids.
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Affiliation(s)
- Zahra Jalali
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Building Number 1, Emam Ali Boulevard, P.O. Box: 77175-835, 7719617996, Rafsanjan, Iran
- Department of Clinical Biochemistry, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Morteza Khademalhosseini
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Building Number 1, Emam Ali Boulevard, P.O. Box: 77175-835, 7719617996, Rafsanjan, Iran
- Department of Pathology, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Narjes Soltani
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Building Number 1, Emam Ali Boulevard, P.O. Box: 77175-835, 7719617996, Rafsanjan, Iran
| | - Ali Esmaeili Nadimi
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Building Number 1, Emam Ali Boulevard, P.O. Box: 77175-835, 7719617996, Rafsanjan, Iran.
- Department of Cardiology, School of Medicine, Rafsanjani University of Medical Sciences, Rafsanjan, Iran.
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Sari C, Özer Sarı S, Duran Karaduman B, Koseoglu H, Şimşek EÇ. Assessment of left ventricular contractile functions in inflammatory bowel disease according to disease activity. J Dig Dis 2020; 21:629-638. [PMID: 32964644 DOI: 10.1111/1751-2980.12943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/30/2020] [Accepted: 09/20/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The study aimed to investigate the subclinical involvement of cardiac functions in patients with inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD) according to their disease activity status by two-dimensional speckle tracking echocardiography (2DSTE). METHODS This prospective study included 72 consecutive patients with IBD and 93 age- and sex-matched healthy controls (HC). All participants underwent conventional and 2DSTE assessments. The IBD patients were subdivided into active disease and remission groups for further investigation of the effect of disease activity on left ventricular (LV) contractile functions. RESULTS The longitudinal strain values differed significantly between the IBD group and the control group (global longitudinal strain [GLS] from two-chamber view: [-15.74 ± 6.33]% vs [-18.8 ± 2.87]%, P = 0.001; GLS from four-chamber view: [-16.61 ± 9.91]% vs [-20.12 ± 2.57]%, P = 0.008; GLS: [-15.47 ± 6.87]% vs [-19.48 ± 2.16]%, P = 0.0001). The circumferential strain measurements showed a nonsignificant trend of depressed contractile functions in the IBD group. Patients with active IBD had similar GLS and global circumferential strain (GCS) values as those in remission. A correlation analysis revealed that the neutrophil-lymphocyte ratio was positively correlated and the platelet count was negatively correlated with GCS. Deterioration of LV diastolic functions examined with E/e' and mitral deceleration time was found in the IBD group compared with the controls. CONCLUSIONS LV global longitudinal contractile and diastolic functions were decreased in patients with IBD. Clinicians should maintain patients' remission periods and prevent flare-ups.
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Affiliation(s)
- Cenk Sari
- Department of Cardiology, Tepecik Education and Research Hospital, İzmir, Turkey
| | - Sevil Özer Sarı
- Department of Gastroenterology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Bilge Duran Karaduman
- Department of Cardiology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Huseyin Koseoglu
- Department of Gastroenterology, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Ersin Çağrı Şimşek
- Department of Cardiology, Tepecik Education and Research Hospital, İzmir, Turkey
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Konst RE, Guzik TJ, Kaski JC, Maas AHEM, Elias-Smale SE. The pathogenic role of coronary microvascular dysfunction in the setting of other cardiac or systemic conditions. Cardiovasc Res 2020; 116:817-828. [PMID: 31977015 PMCID: PMC7526753 DOI: 10.1093/cvr/cvaa009] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/09/2019] [Accepted: 01/21/2020] [Indexed: 12/13/2022] Open
Abstract
Coronary microvascular dysfunction (CMD) plays a pathogenic role in cardiac and systemic conditions other than microvascular angina. In this review, we provide an overview of the pathogenic role of CMD in the setting of diabetes mellitus, obesity, hypertensive pregnancy disorders, chronic inflammatory and autoimmune rheumatic disorders, chronic kidney disease, hypertrophic cardiomyopathy, and aortic valve stenosis. In these various conditions, CMD results from different structural, functional, and/or dynamic alterations in the coronary microcirculation associated with the primary disease process. CMD is often detectable very early in the course of the primary disease, before clinical symptoms or signs of myocardial ischaemia are present, and it portrays an increased risk for cardiovascular events.
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Affiliation(s)
- Regina E Konst
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow, UK
| | - Juan-Carlos Kaski
- The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network, Coronary Vasomotion Disorders International Study Group (COVADIS), Adelaide, Australia.,Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Suzette E Elias-Smale
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
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Abstract
Many patients with chest pain undergoing coronary angiography do not show significant obstructive coronary lesions. A substantial proportion of these patients have abnormalities in the function and structure of coronary microcirculation due to endothelial and smooth muscle cell dysfunction. The coronary microcirculation has a fundamental role in the regulation of coronary blood flow in response to cardiac oxygen requirements. Impairment of this mechanism, defined as coronary microvascular dysfunction (CMD), carries an increased risk of adverse cardiovascular clinical outcomes. Coronary endothelial dysfunction accounts for approximately two-thirds of clinical conditions presenting with symptoms and signs of myocardial ischemia without obstructive coronary disease, termed "ischemia with non-obstructive coronary artery disease" (INOCA) and for a small proportion of "myocardial infarction with non-obstructive coronary artery disease" (MINOCA). More frequently, the clinical presentation of INOCA is microvascular angina due to CMD, while some patients present vasospastic angina due to epicardial spasm, and mixed epicardial and microvascular forms. CMD may be associated with focal and diffuse epicardial coronary atherosclerosis, which may reinforce each other. Both INOCA and MINOCA are more common in females. Clinical classification of CMD includes the association with conditions in which atherosclerosis has limited relevance, with non-obstructive atherosclerosis, and with obstructive atherosclerosis. Several studies already exist which support the evidence that CMD is part of systemic microvascular disease involving multiple organs, such as brain and kidney. Moreover, CMD is strongly associated with the development of heart failure with preserved ejection fraction (HFpEF), diabetes, hypertensive heart disease, and also chronic inflammatory and autoimmune diseases. Since coronary microcirculation is not visible on invasive angiography or computed tomographic coronary angiography (CTCA), the diagnosis of CMD is usually based on functional assessment of microcirculation, which can be performed by both invasive and non-invasive methods, including the assessment of delayed flow of contrast during angiography, measurement of coronary flow reserve (CFR) and index of microvascular resistance (IMR), evaluation of angina induced by intracoronary acetylcholine infusion, and assessment of myocardial perfusion by positron emission tomography (PET) and magnetic resonance (CMR).
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Affiliation(s)
- Federico Vancheri
- Department of Internal Medicine, S.Elia Hospital, 93100 Caltanissetta, Italy
| | - Giovanni Longo
- Cardiovascular and Interventional Department, S.Elia Hospital, 93100 Caltanissetta, Italy;
| | - Sergio Vancheri
- Radiology Department, I.R.C.C.S. Policlinico San Matteo, 27100 Pavia, Italy;
| | - Michael Henein
- Institute of Public Health and Clinical Medicine, Umea University, SE-90187 Umea, Sweden;
- Department of Fluid Mechanics, Brunel University, Middlesex, London UB8 3PH, UK
- Molecular and Nuclear Research Institute, St George’s University, London SW17 0RE, UK
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Packer M, Lam CS, Lund LH, Maurer MS, Borlaug BA. Characterization of the inflammatory-metabolic phenotype of heart failure with a preserved ejection fraction: a hypothesis to explain influence of sex on the evolution and potential treatment of the disease. Eur J Heart Fail 2020; 22:1551-1567. [PMID: 32441863 PMCID: PMC7687188 DOI: 10.1002/ejhf.1902] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/05/2020] [Accepted: 05/17/2020] [Indexed: 12/11/2022] Open
Abstract
Accumulating evidence points to the existence of an inflammatory-metabolic phenotype of heart failure with a preserved ejection fraction (HFpEF), which is characterized by biomarkers of inflammation, an expanded epicardial adipose tissue mass, microvascular endothelial dysfunction, normal-to-mildly increased left ventricular volumes and systolic blood pressures, and possibly, altered activity of adipocyte-associated inflammatory mediators. A broad range of adipogenic metabolic and systemic inflammatory disorders - e.g. obesity, diabetes and metabolic syndrome as well as rheumatoid arthritis and psoriasis - can cause this phenotype, independent of the presence of large vessel coronary artery disease. Interestingly, when compared with men, women are both at greater risk of and may suffer greater cardiac consequences from these systemic inflammatory and metabolic disorders. Women show disproportionate increases in left ventricular filling pressures following increases in central blood volume and have greater arterial stiffness than men. Additionally, they are particularly predisposed to epicardial and intramyocardial fat expansion and imbalances in adipocyte-associated proinflammatory mediators. The hormonal interrelationships seen in inflammatory-metabolic phenotype may explain why mineralocorticoid receptor antagonists and neprilysin inhibitors may be more effective in women than in men with HFpEF. Recognition of the inflammatory-metabolic phenotype may improve an understanding of the pathogenesis of HFpEF and enhance the ability to design clinical trials of interventions in this heterogeneous syndrome.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular InstituteBaylor University Medical CenterDallasTXUSA
- Imperial College LondonLondonUK
| | - Carolyn S.P. Lam
- National Heart Centre Singapore and Duke‐National University of SingaporeSingapore
- University Medical Centre GroningenGroningenThe Netherlands
- The George Institute for Global HealthSydneyAustralia
| | - Lars H. Lund
- Department of Medicine, Karolinska Institutet and Heart and Vascular ThemeKarolinska University HospitalStockholmSweden
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Kul Ş, Çalışkan Z, Güvenç TS, Güvenç RÇ, Çalışkan M. Plasma lipids in patients with inflammatory bowel disease : Observations on the associations between lipid indices and coronary flow reserve. Wien Klin Wochenschr 2020; 132:283-294. [PMID: 32347376 DOI: 10.1007/s00508-020-01649-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 03/28/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIMS Patients with inflammatory bowel disease (IBD) are at increased risk for coronary artery disease (CAD), even after adjusting for traditional risk factors for atherosclerosis. While inflammation is widely regarded as the pathophysiologic link between IBD and CAD, the exact mechanisms are largely unknown. This study was conducted to investigate the association of lipid parameters and indices with coronary flow reserve and markers of inflammation in IBD patients. METHODS A total of 73 patients with IBD and 26 healthy controls were enrolled. Patients in the IBD arm were either in remission or had mild disease activity. Lipid parameters, C‑reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were analyzed using standard laboratory techniques. Coronary flow reserve (CFR) was measured using two-dimensional echocardiography. RESULTS Both CRP and ESR were higher and CFR was significantly lower in IBD patients, but there were no differences in terms of lipid parameters or indices; however, patients with IBD and a CFR <2.0 had significantly higher triglyceride (TG) level (155.0 (80.0) mg/dl vs. 108.0 (68.0) mg/dl, p < 0.001) and there was a strong trend towards lower high-density lipoprotein (HDL) cholesterol (40.0 (8.5) mg/dl vs. 45.0 (10.0) mg/dl, p = 0.05) level in the latter group when compared to patients with a CFR ≥2.0. The atherogenic index of plasma (AIP), measured as log(TG/HDL-C) had the best predictive value for CFR in IBD group and was an independent predictor of CFR after multivariate adjustment for confounders (unstandardized coefficient: -0.75, 95% CI: (-1.13)-(-0.37)), β = -0.41, p = <0.001). CONCLUSION The atherogenic index of plasma is a marker for reduced CFR in IBD patients and could be useful to screen those at risk for early atherogenesis and CAD.
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Affiliation(s)
- Şeref Kul
- Medicine of Faculty, Division of Cardiology, Istanbul Medeniyet University, Istanbul, Turkey.
| | - Zuhal Çalışkan
- Department of Gastroenterology, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Tolga Sinan Güvenç
- Faculty of Medicine and Dentistry, Department of Internal Medicine, Division of Cardiology, University of Alberta, Edmonton, AB, Canada
| | - Rengin Çetin Güvenç
- Division of Cardiology, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey
| | - Mustafa Çalışkan
- Medicine of Faculty, Division of Cardiology, Istanbul Medeniyet University, Istanbul, Turkey
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Erolu E, Polat E. Cardiac functions and aortic elasticity in children with inflammatory bowel disease: effect of age at disease onset. Cardiol Young 2020; 30:313-7. [PMID: 31964454 DOI: 10.1017/S1047951119002932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM Childhood onset inflammatory bowel disease is more aggressive and has rapidly progressive clinical course than adult inflammatory bowel disease. Early-onset inflammatory bowel disease has more severe clinical progression as a subspecialised group of monogenic inflammatory bowel disease. We studied cardiac functions and aortic elasticity in children with early- and late-onset inflammatory bowel disease in remission period. METHODS Thirty-three paediatric patients were divided into subgroups according to age of disease onset (<10 and >10 years of age). Twenty-five healthy children were admitted as control group. M-Mode echocardiography and pulsed wave Doppler echocardiography were performed. Strain, distensibility, stiffness index of ascending, and abdominal aorta were evaluated. RESULTS Interventricular septum (mm) and left ventricular end-systolic diameter were higher (6.9 ± 1.2, 26.2 ± 4.6) in early-onset inflammatory bowel disease patients than control patients (6.1 ± 1.27, 22.7 ± 4.12) (p = 0.050, p = 0.050). Mitral E/E' ratio and myocardial performance index were increased in inflammatory bowel disease and early-onset inflammatory bowel disease groups than control group (p = 0.046, p = 0.04; p = 0.023, p = 0.033). Diastolic functions were found to be impaired in inflammatory bowel disease and early-onset inflammatory bowel disease groups according to control group, while there was no difference between late-onset inflammatory bowel disease and control groups in terms of diastolic functions. Mitral E/A ratio was lower in inflammatory bowel disease patients and early-onset inflammatory bowel disease patients (1.46 ± 0.32, 1.4 ± 0.21) than control patients (1.70 ± 0.27) (p = 0.013, p = 0.004). Aortic elasticity did not differ between groups. CONCLUSION Chronic low-grade inflammation has effects on left ventricular diameters and diastolic function in remission period. Aortic elasticity is not affected in our study groups.
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Caliskan Z, Telci Caklili O, Kahraman R, Ozcan FB, Sayar S, Kostek O, Demircioglu K, Yilmaz Y, Kul S, Caliskan M. Does celiac disease impair coronary microvascular circulation: Coronary flow velocity reserve of patients with celiac disease. Echocardiography 2019; 37:34-40. [PMID: 31816123 DOI: 10.1111/echo.14554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/12/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Celiac disease (CD) is an enteropathy characterized with immune reaction to gliadin protein. AIM In this study, we aimed to assess effect of CD on coronary microvascular circulation and the association between coronary flow velocity reserve (CFVR) and hs-CRP/Albumin ratio. MATERIAL AND METHODS Study was conducted between March 2017 and November 2018 with CD at Umraniye Training and Research Hospital Gastroenterology Clinic. CFVR was defined as the ratio of hyperemic to baseline diastolic peak velocities. CFVR ≥ 2.0 was considered normal. C-reactive protein/albumin ratio (CAR) was calculated as hs-CRP/albumin. RESULTS Serum albumin (4.27 ± 0.56 vs 4.50 ± 0.34; P value: .04) level was significantly lower in celiac group but higher Hs-CRP (2.44 ± 1.24 vs 1.82 ± 1.29; P value < .01), hs-CRP/albumin ratio (0.57 ± 0.30 vs 0.41 ± 0.31; P value: .03) were recorded in celiac group. Both hyperemic flow and CFVR substantially lower in the celiac group compared to controls. In univariate analysis; age, hs-CRP, and hs-CRP/albumin ratio were associated with low CFVR and hs-CRP/albumin level was an accurate predictor of low CFVR at the ROC curve. CONCLUSION In this study, we found that in patients with CD, coronary flow reserve is impaired.
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Affiliation(s)
- Zuhal Caliskan
- Gastroenterology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Ozge Telci Caklili
- Department of Endocrinology and Metabolism, Istanbul University Istanbul Medical School, Istanbul, Turkey
| | - Resul Kahraman
- Gastroenterology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Fatma Betul Ozcan
- Cardiology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Suleyman Sayar
- Gastroenterology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | | | - Kenan Demircioglu
- Cardiology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Yusuf Yilmaz
- Cardiology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Seref Kul
- Cardiology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Caliskan
- Cardiology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
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Packer M. Drugs That Ameliorate Epicardial Adipose Tissue Inflammation May Have Discordant Effects in Heart Failure With a Preserved Ejection Fraction as Compared With a Reduced Ejection Fraction. J Card Fail 2019; 25:986-1003. [DOI: 10.1016/j.cardfail.2019.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/28/2019] [Accepted: 09/03/2019] [Indexed: 02/08/2023]
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Caliskan Z, Tatlisu MA, Kahraman R, Gokturk S, Sayar S, Kostek O, Kul S, Baycan OF, Ozcan FG, Caliskan M. The Impact of Prognostic Nutritional Index on Coronary Flow Reserve in Patients with Inflammatory Bowel Disease. Medeni Med J 2019; 34:271-277. [PMID: 32821448 PMCID: PMC7433735 DOI: 10.5222/mmj.2019.47108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/24/2019] [Indexed: 11/05/2022] Open
Abstract
Objective The recurring inflammation of mucosal layer of intestines is known as inflammatory bowel disease (IBD), which can be accompanied by nutritional deficiencies. The association between inflammation and coronary artery disease has been established. Coronary flow reserve (CFR), which is an established method to evaluate combined microvascular and epicardial flow of coronary arteries, can be assessed by using transthoracic echocardiography. The aim of this study was to evaluate the association of Prognostic Nutritional Index (PNI) with CFR in IBD patients. Method This prospective study included 101 patients with IBD. These patients were compared to control group (n=32). PNI was calculated by using serum albumin level and lymphocyte count. CFR was assessed by using Doppler echocardiography. Results Multivariate regression analysis indicated that the presence of IBD, age (>40 years) and decreased PNI (<53.8) independently predict impairment of CFR. The area under the curve (AUC) was 75.1% (95% CI:0.664-0.838), and PNI levels were significant predictor of low CFR (p<0.001). Conclusion This study showed that PNI, which is calculated using the serum level of albumin and lymphocyte count, is a strong predictor of decreased CFR in IBD patients in remission. Our findings support previous studies showing the relationship between PNI and coronary artery disease. This immunonutritional index has only two components and is easy to calculate, and inexpensive.
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Affiliation(s)
- Zuhal Caliskan
- Istanbul Umraniye Training and Research Hospital, Department of Gastroenterology, Istanbul, Turkey
| | - Mustafa Adem Tatlisu
- Istanbul Medeniyet University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Resul Kahraman
- Istanbul Umraniye Training and Research Hospital, Department of Gastroenterology, Istanbul, Turkey
| | - Savas Gokturk
- Baskent University Faculty of Medicine, Department of Gastroenterology, Konya, Turkey
| | - Suleyman Sayar
- Istanbul Umraniye Training and Research Hospital, Department of Gastroenterology, Istanbul, Turkey
| | - Osman Kostek
- Baskent University Faculty of Medicine, Department of Gastroenterology, Konya, Turkey
| | - Seref Kul
- Istanbul Medeniyet University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Omer Faruk Baycan
- Istanbul Medeniyet University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Fatma Gül Ozcan
- Istanbul Medeniyet University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Mustafa Caliskan
- Istanbul Medeniyet University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
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15
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Caliskan Z, Demircioglu K, Sayar S, Kahraman R, Caklili O, Ozcan FB, Kostek O, Baycan OF, Doganay HL, Caliskan M. Lipid profile, atherogenic indices, and their relationship with epicardial fat thickness and carotid intima-media thickness in celiac disease. North Clin Istanb 2019; 6:242-7. [PMID: 31650110 DOI: 10.14744/nci.2019.54936] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/09/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE: In this study, we aimed to investigate the presence of subclinical atherosclerosis by measuring epicardial fat thickness (EFT) and carotid intima–media thickness (cIMT), evaluate low-level inflammation with high-sensitivity C-reactive protein (hsCRP), and evaluate whether there is a relationship among lipid profile, atherogenic indices, and hsCRP with these subclinical atherosclerosis markers in patients with celiac disease (CD). METHODS: After exclusion and inclusion criteria were applied, 31 patients with CD (24 female, mean age: 39.4±12.3 years) and 32 healthy controls (21 female, mean age: 39.5±4.4 years), totally 63 cases, were recruited. Subclinical atherosclerosis was evaluated with EFT by transthoracic echocardiography and cIMT by ultrasonography. Inflammatory markers including erythrocyte sedimentation rate (ESR), hsCRP, and lipid profile were recorded. Also, atherogenic indices were calculated: Castelli risk index I and II (TG/HDL-c and LDL-c/HDL-c, respectively), atherogenic index of plasma (AIP; logarithm TG/HDL-c), non-HDL-c (TG-HDL-c), and atherogenic coefficient (AC; non-HDL-c/HDL-c). RESULTS: EFT was significantly higher in the CD group (0.49±0.10 vs. 0.49±0.09; p-value: 0.02). Although cIMT was higher in the patient group, it did not reach statistical significance (0.51±0.08, 0.47±0.08; p-value: 0.10). HDL cholesterol level was found to be significantly lower (42.0±8.8 vs. 50.0±13.7; p-value: 0.01), and the plasma atherogenic index was found to be significantly higher in the patient group (0.98±0.50 vs. 0.62±0.64; p-value: 0.02). hsCRP (3.51±3.18 vs. 1.92±1.40; p-value: 0.02) and ESR (17.2±12.8 with 9.7±3.1; p-value: 0.01) were found to be significantly higher in the CD group. Although there was a significant positive correlation between EFT and hsCRP (r: 0.453; p-value: 0.01), there was a significant negative correlation between cIMT and HDL-cholesterol (−0.339; p-value: 0.05), and a significant positive correlation with the other components of the atherogenic index was found. CONCLUSION: The risk of atherosclerosis has been increased in patients with CD. Chronic inflammation may be responsible for this increase along with atherogenic indices.
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Abstract
AIM Identification of subclinical and metamanifests state changes of cardiovascular system in patients with functional and inflammatory bow- el diseases (IBD) without a background of cardiac pathology. MATERIALS AND METHODS Was examined 79 patients with colon diseases, 20 patients were diagnosed with irritable bowel syndrome (IBS) with diarrhea, a 37 - undifferentiated colitis (UdC) and 22 patients with ulcerative colitis (UC). As a control group were examined in 50 healthy subjects. All patients received treatment in accordance with international and national guidelines. Prescribed medications had effect on the function of the cardiovascular system. Patients with contacting the hospital and against the onset of remission was performed ultrasound of the heart. Determines the size of the left atrium, heart rate, end-diastolic volume, end-systolic volume, ejection fraction (EF), cardiac index (CI), to- tal peripheral vascular resistance, the presence of right heart failure, blood flow, the area of the right atrium and right ventricle in systole and diastole, and calculated the proportion of contractility of the right atrium and right ventricle. Determined systolic pressure in PA (SPPA), the average pressure in PA (SPPA). RESULTS Clinical manifestations of cardiac syndrome was identified in 75,0% of patients with IBS, 54,1% of patients NK and 68,2% patients with UC. When performing correlation analysis in the patients with UdC and UC was noted the relationship of hemodynamic parameters and disease severity was more pronounced in UC. So, when comparing the duration of the disease and levels of the MLC - r=0,52 and r=0,73 (p<0,05), EF - r=-0,51 and r=-0,71 (p<0,05), CI - r=0,49 and r=0,70 (p<0,05), heart rate - r=0,47, r=0,68 (p<0,05); duration of stay in hospi- tal and the magnitudes of MLC - r=0,54 and r=0,77 (p<0,05), EF - r=-0,51 and r=-0,71 (p<0.05), CI - r=0,55 and r=0,73 (p<0,05), heart rate - r=0,47, r=0,63 (p<0,05). For patients with UC, we noted the presence of correlation when the average frequency of exacerbations per year and the values of the MLC - r=0,53 (p<0,05), EF - r=-0,55 (p<0,05), heart rate: r=0,54 (p<0,05); severity of UC and EF (r=-0,67; p<0,05). A statistically significant correlation of changes in EF and value SPPA and APPA, aggravated by the deepening severity of the disease. So, for IBS - r=-0,46, and r=-0,48 (p<0,05); for NK - r=-0,51 and r=-0,59 (p<0,05); for the UC - r=-0,62, and r=-0,67 (p<0,05). In the analysis of duration of hospitalization, and values SPPA and APPA for patients with IBS - r=0.48 and r=0.46 (p<0,05); with UdC - r=0,50 and r=0,53 (p<0,05); with UC - r=0,59 and r=0,62 (p<0,05). Sick UC was characterized by the greatest dilatation of RA and RV with access from outside the variations of the norms of 90.9 and 68.2 per cent, a significant decrease dRA and dRV. Discovered correlation of the squares of PP and SDL - r=0,48, r=0,54 and r=0,61 (p<0,05); APPA - r=0,50, r=0,56 and r=0,63 (p<0,05); RV areas and levels SPPA - r=0,45, r=0,50 and r=0.52 (p<0,05); and APPA - r=0,46, r=0,47 r=0,53 (p<0,05). When analyzing the values of the squares of the pancreas and MLC - r=0,47 r=0,54 and r=0,61 (p<0,05), levels of EF and dRV - r=0,41, r=0,50 and r=0,56 (p<0,05). CONCLUSION Cardiac syndrome in patients with IBS and IBD without a background of cardiac pathology can occur in the form of subclinical or manifested weakly, but persistent changes that may not be recognized, but in the future may complicate the course of the underlying dis- ease, necessitating research to develop tactics to correct them.
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Affiliation(s)
- I V Maev
- A.I. Evdokimov Moscow state medical dental University, Ministry of health of Russia, Moscow, Russia
| | - A N Kazulin
- A.I. Evdokimov Moscow state medical dental University, Ministry of health of Russia, Moscow, Russia
| | - D N Andreev
- A.I. Evdokimov Moscow state medical dental University, Ministry of health of Russia, Moscow, Russia
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Packer M. The conundrum of patients with obesity, exercise intolerance, elevated ventricular filling pressures and a measured ejection fraction in the normal range. Eur J Heart Fail 2018; 21:156-162. [PMID: 30561120 DOI: 10.1002/ejhf.1377] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/14/2018] [Accepted: 11/03/2018] [Indexed: 01/15/2023] Open
Abstract
Patients with obesity, a reduced exercise capacity, increased cardiac filling pressures and a measured left ventricular ejection fraction in the normal range do not have a homogeneous disorder, but instead, exhibit one of three phenotypes. First, many obese people exhibit sodium retention, plasma volume expansion and cardiac enlargement, and some are likely to have heart failure that is related to hypervolaemia, even though cardiac index and circulating levels of natriuretic peptides are not meaningfully increased. Second, in some middle-aged men and women (particularly those with minimal co-morbidities), levels of natriuretic peptides increase markedly and can lower systemic vascular resistance, thus leading to high-output heart failure (HOHF) and glomerular hyperfiltration. Third, older obese people, particularly women with multiple co-morbidities, exhibit the syndrome of heart failure with a preserved ejection fraction (HFpEF). Despite degrees of plasma volume expansion similar to HOHF, these patients exhibit only modestly increased ventricular dimensions and circulating levels of natriuretic peptides (despite a high prevalence of atrial fibrillation), and glomerular function is characteristically impaired. A conceptual framework is proposed to distinguish among the three phenotypes seen in obese patients with exercise intolerance, increased ventricular filling pressures and a measured left ventricular ejection fraction in the normal range, since they may respond differently to therapeutic interventions. Efforts are needed to enhance the recognition of heart failure in obese people and to ensure that clinical trials that are designed to study patients with HFpEF actually enrol those who have the disease.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA
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Szczeklik K, Mach T, Cibor D, Owczarek D, Sapa J, Papież M, Pytko-Polończyk J, Krzyściak W. Correlation of Paraoxonase-1 with the Severity of Crohn's Disease. Molecules 2018; 23:E2603. [PMID: 30314292 DOI: 10.3390/molecules23102603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/05/2018] [Accepted: 10/08/2018] [Indexed: 12/17/2022] Open
Abstract
Diagnostics of Crohn’s disease (CD) requires noninvasive biomarkers facilitating early detection and differentiation of the disease. Therefore, in this study, we aimed to determine the relationship between paraoxonase-1 (PON-1), the severity of CD, oxidative stress, and inflammation in CD. The CD activity index was based on the current classification. Plasma PON-1 was measured in 47 patients with CD, and in 23 control volunteers. Using quantitative variables such as receiver operating characteristics (ROC) (area under the curve (AUC)), the diagnostic utility of PON-1 in differentiating the severity of CD was assessed. Circulating PON-1 was found to be decreased in the CD group compared to the control group (269.89 vs. 402.56 U/L, respectively), and it correlated well with the disease activity. PON-1 correlated positively with hemoglobin (Hb) (r = 0.539, p < 0.001), hematocrit (Ht) (r = 0.48, p < 0.001), total cholesterol (TC) (r = 0.343, p < 0.001), high density lipoprotein (HDL) (r = 0.536, p < 0.001), low density lipoprotein (LDL) (r = 0.54, p < 0.001), and triglyceride (TG) (r = 0.561, p < 0.001) and correlated negatively with white blood cell count (WBC) (r = −0.262, p = 0.029), platelet count (PLT) (r = −0.326, p = 0.006), C-reactive protein (CRP) (r = −0.61, p < 0.001), and malondialdehyde (MDA) (r = −0.924, p < 0.001). PON-1 as a marker for CD differentiation possessed a sensitivity and specificity of 93.62% and 91.30%, respectively. CD was found to be associated with the decrease in the levels of PON-1, which correlates well with activity of the disease and reflects the intensification of inflammation, as well as intensified lipid peroxidation. High sensitivity and specificity of PON-1 determines its selection as a good screening test for CD severity.
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Hensel KO, Abellan Schneyder FE, Wilke L, Heusch A, Wirth S, Jenke AC. Speckle Tracking Stress Echocardiography Uncovers Early Subclinical Cardiac Involvement in Pediatric Patients with Inflammatory Bowel Diseases. Sci Rep 2017; 7:2966. [PMID: 28592829 PMCID: PMC5462781 DOI: 10.1038/s41598-017-03255-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/04/2017] [Indexed: 12/20/2022] Open
Abstract
Inflammatory bowel disease (IBD) is an established risk factor for cardiovascular disease (CVD). However, whether cardiac consequences present early in IBD is unknown. This is the first study in children aiming to unmask altered myocardial mechanics in IBD. We enrolled 50 consecutive normotensive children with Crohn’s disease (CD) (n = 28) or ulcerative colitis (UC) (n = 22). The study groups consisted of 18 patients with active inflammatory disease (mean age 14.6 ± 2.5 years) and 32 children with IBD in remission (14.3 ± 2.3 years). 60 age- and gender-matched children served as healthy controls. Speckle tracking stress echocardiography (STE) was used to assess left ventricular (LV) myocardial strain and strain rate. Circumferential strain rate was significantly decreased in children with active IBD (−1.55 ± 0.26 s−1) and IBD in remission (−1.49 ± 0.26 s−1) versus healthy controls (1.8 ± 0.4 s−1) both at rest (p < 0.001) and during exercise (p = 0.021). Moreover, longitudinal strain rate, circumferential strain and E/E′ ratio were significantly impaired in IBD. Pediatric patients with IBD feature subclinical signs of LV systolic and diastolic myocardial impairment early in the course of CD and UC. This may not be reversible even when IBD is clinically controlled. Patients with IBD should be regularly screened for signs of CVD.
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Affiliation(s)
- Kai O Hensel
- HELIOS University Medical Center Wuppertal, Children's Hospital, Department of Pediatric Gastroenterology, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Witten, Germany. .,HELIOS University Medical Center Wuppertal, Children's Hospital, Department of Pediatric Cardiology, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Witten, Germany.
| | - Francisca E Abellan Schneyder
- HELIOS University Medical Center Wuppertal, Children's Hospital, Department of Pediatric Cardiology, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Witten, Germany
| | - Lucia Wilke
- HELIOS University Medical Center Wuppertal, Children's Hospital, Department of Pediatric Cardiology, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Witten, Germany
| | - Andreas Heusch
- HELIOS University Medical Center Wuppertal, Children's Hospital, Department of Pediatric Cardiology, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Witten, Germany
| | - Stefan Wirth
- HELIOS University Medical Center Wuppertal, Children's Hospital, Department of Pediatric Gastroenterology, Center for Clinical & Translational Research (CCTR), Faculty of Health, Center for Biomedical Education & Research (ZBAF), Witten/Herdecke University, Faculty of Health, Witten, Germany
| | - Andreas C Jenke
- EKO Children's Hospital, Department of Pediatric Gastroenterology, Oberhausen, Witten/Herdecke University, Faculty of Health, Witten, Germany
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Ozdil K, Caliskan Z, Keles N, Ozturk O, Tekin AS, Kahraman R, Doganay L, Demircioglu K, Yilmaz Y, Caliskan M. Echocardiographic epicardial fat thickness measurement: A new screening test for subclinic atherosclerosis in patients with inflammatory bowel diseases. North Clin Istanb 2017; 4:4-12. [PMID: 28752137 DOI: 10.14744/nci.2017.74508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/10/2017] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE: Inflammatory bowel diseases (IBD) consist of a number of chronic inflammatory diseases. Inflammatory process is known to be involved in all stages of atherosclerosis. Early atherosclerosis is reflected by increased levels of carotid artery intima media thickness (c-IMT) and high-sensitivity C-reactive protein (hs-CRP). Epicardial fat thickness (EFT) strongly influences both the formation and progression of atherosclerosis. Recent studies have demonstrated a relationship between c-IMT and hs-CRP levels and the risk of atherosclerosis in patients with IBD. However, no study has yet compared EFT between patients with IBD and the general healthy population. Hence, this study was designed to further evaluate whether patients with IBD have higher EFT values with increased c-IMT and hs-CRP levels compared to those in the healthy population. METHODS: A total of 110 patients with IBD and 105 healthy volunteers were enrolled into this study. EFT was evaluated by transthoracic echocardiography. c-IMT levels were measured using an ultrasound scanner with a linear probe. The plasma levels of hs-CRP were measured using a highly sensitive sandwich ELISA technique. RESULTS: The hs-CRP and c-IMT levels of patients with IBD were significantly higher than those of the control group. The EFT values of patients with IBD were significantly higher than those of the control group (0.54±0.13 vs. 0.49±0.09, p=0.002). CONCLUSION: Echocardiographic EFT measurements of patients with IBD were significantly higher than those of the normal population, which may be associated with an increased subclinical atherosclerosis risk in these patients.
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Caliskan Z, Keles N, Kahraman R, Özdil K, Karagoz V, Aksu F, Aciksari G, Yilmaz Y, Kul S, Caliskan M. Imparied retrobulbar blood flow and increased carotid IMT in patients with Crohn's disease. Int J Cardiovasc Imaging 2016; 32:1617-23. [PMID: 27522671 DOI: 10.1007/s10554-016-0956-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/02/2016] [Indexed: 12/22/2022]
Abstract
Crohn's Disease [CD] is one of the Inflammatory Bowel Diseases that are chronic relapsing inflammatory diseases. Despite the major affected organ is intestine in CD, extra intestinal organs and tissues including cardiovascular system are also affected. Several studies have demonstrated that CD patients may have a higher risk of advancing atherosclerosis. The microvascular endothelial dysfunction plays an essential role for developing coronary atherosclerosis. Microvascular structural abnormalities in the retinal circulation may predict macrovascular events such as stroke and coronary heart disease. In order to assess the the microvascular circulation of the retina; retrobulbar blood flow velocities and resisitive indices [RI] of retrobulbar arteries are measured. The carotid intima media thickness [CIMT] correlates strongly with CV risk in the future. We aimed to investigate whether calculation of RI of retrobulbar arteries can be used as novel, easy and reproducible method to define atherosclerotic risk in CD patients along with CIMT. Thirty CD patients with remission period and thirty healthy volunteers were enrolled in the study. Measurement of carotid intima-media thickness and retrobulbar blood flow velocities were obtained with ultrasound scanner and colour Doppler ultrasonography. The RI of the OA [0.77 ± 0.06 vs. 0.65 ± 0.06, p < 0.001] and CIMT 0.52 [0.50-0.60] vs. 0.40 [0.40-0.50] in patients with CD was significantly higher than the control group. Increased OARI and CIMT values may reflect an increased risk of atherosclerosis and OARI measurement may be used as a screening test for microvascular circulation evaluation in patients with CD.
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Caliskan Z, Keles N, Gokturk HS, Ozdil K, Aksu F, Ozturk O, Kahraman R, Kostek O, Tekin AS, Ozgur GT, Caliskan M. Is activation in inflammatory bowel diseases associated with further impairment of coronary microcirculation? Int J Cardiol 2016; 223:176-181. [PMID: 27541650 DOI: 10.1016/j.ijcard.2016.08.141] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 08/05/2016] [Accepted: 08/06/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Inflammatory bowel disease [IBD] includes a number of chronic relapsing diseases. In IBD intestinal microvascular endothelial cells are damaged by an abnormal immune response. Several studies have shown that IBD may cause increment in risk of developing atherosclerosis. IBD in activation was related to enhanced risks of worse cardiovascular [CV] outcome, on the other hand no risk increment was seen in remission comparing to control group in those studies. Coronary Flow Reserve [CFR] reflects coronary microvascular circulation. Coronary microvascular dysfunction may be defined as a predictor of CV outcome combined with previous described atherosclerotic risk factors. The present study was purposed to further evaluate whether or not CFR in the left anterior descending artery [LAD] is disturbed in IBD patients with activation in comparison to remission and healthy subjects. METHODS 62 patients with IBD and 39 healthy volunteers were enrolled into the study. Patients' demographics were recorded. CFR evaluation of patients with IBD in both activation and remission period and control group were performed with transthoracic echocardiography. RESULTS CFR was significantly lowest in the active period of the IBD [2.26 [2.08-2.55] vs. 2.55 [2.18-3.00] and 3.10 [2.85-3.29] p<0.001]. CFR is negatively correlated with disease activity scores of IBD. CONCLUSION This study showed that CFR is more prominently disturbed in patients with IBD in activation. The activation of disease may have a major role in the progression of coronary microcirculatory dysfunction and future cardiovascular events.
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Affiliation(s)
- Zuhal Caliskan
- Baskent University Department of Gastroenterology, Konya, Turkey
| | - Nursen Keles
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
| | | | - Kamil Ozdil
- Umraniye Training and Research Hospital Department of Gastroenterology, Istanbul,Turkey
| | - Feyza Aksu
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Oguzhan Ozturk
- Umraniye Training and Research Hospital Department of Gastroenterology, Istanbul,Turkey
| | - Resul Kahraman
- Umraniye Training and Research Hospital Department of Gastroenterology, Istanbul,Turkey
| | - Osman Kostek
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Internal Medicine, Istanbul, Turkey
| | - Ahmet S Tekin
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | | | - Mustafa Caliskan
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
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Bulut M, Keles N, Caliskan Z, Kostek O, Aksu F, Ozdil K, Akcakoyun M, Demircioglu K, Yilmaz Y, Kanbay M, Caliskan M. Is the presence of AA amyloidosis associated with impaired coronary flow reserve? Atherosclerosis 2016; 251:389-395. [DOI: 10.1016/j.atherosclerosis.2016.05.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/16/2016] [Accepted: 05/25/2016] [Indexed: 01/08/2023]
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Wu GC, Leng RX, Lu Q, Fan YG, Wang DG, Ye DQ. Subclinical Atherosclerosis in Patients With Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis. Angiology 2016; 68:447-461. [PMID: 27252243 DOI: 10.1177/0003319716652031] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We evaluated the differences in major markers of cardiovascular (CV) risk between inflammatory bowel diseases (IBDs) and controls by a systematic review and a meta-analysis. We searched PubMed, EMBASE, and Cochrane databases for literature comparing CV risk markers in IBDs and controls. The overall mean carotid intima-media thickness (CIMT), flow-mediated dilation (FMD%), and carotid-femoral pulse wave velocity (cfPWV) difference between patients with IBDs and control groups were calculated. Twenty-eight studies were included in the meta-analysis, including 16 studies with data on CIMT, 7 studies reporting FMD%, and 9 studies on cfPWV. Compared to controls, patients with IBDs showed significantly higher CIMT (standardized mean difference [ SMD]: 0.534 mm; 95% confidence interval [CI], 0.230 to 0.838; P = .001), significantly lower FMD% ( SMD, -0.721%; 95% CI, -1.020 to -0.421; P < .0001), and significantly increased cfPWV ( SMD, 0.849; 95% CI, 0.589 to 1.110; P < .0001). When analyzing subgroups with ulcerative colitis and Crohn disease (CD), all results were still significant except CIMT in CD. Our findings support the current evidence for an elevated CV burden in patients with IBD and support the clinical utility of markers of subclinical atherosclerosis in the management of these patients.
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Affiliation(s)
- Guo-Cui Wu
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Rui-Xue Leng
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Qi Lu
- 2 Department of Clinical Medicine, The College of Clinical Medicine, Anhui Medical University, Hefei, Anhui, China
| | - Yin-Guang Fan
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - De-Guang Wang
- 3 Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Dong-Qing Ye
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
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Nar G, Ergul B, Aksan G, Inci S. Assessment of Atrial Electromechanical Delay and Left Atrial Mechanical Functions in Patients with Ulcerative Colitis. Echocardiography 2016; 33:970-6. [PMID: 27009549 DOI: 10.1111/echo.13213] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Ulcerative colitis (UC) is a common inflammatory bowel disease causing systemic inflammation, which may also affect the cardiovascular system, as well as other organ systems. The aim of the current study was to evaluate left atrial (LA) mechanical functions and duration of atrial electromechanical delay (AEMD) with echocardiography in patients with UC. METHOD A total of 91 patients, 45 with UC (Group 1) and 46 healthy individuals as control (Group 2) were included in the study. The demographic and laboratory data were recorded, and echocardiographic measurements were taken for all patients. RESULTS In the evaluation of basal clinical and laboratory findings, no difference was detected between the two groups, except for white blood cell count (WBC) (8.26 ± 2.71 vs. 7.06 ± 1.70, P = 0.013) and high-sensitivity C-reactive protein (Hs-CRP; 3.4 ± 1.7 vs. 1.0 ± 0.8, P < 0.001). The echocardiographic assessment revealed that the diastolic parameters such as E-, E/A-, and E- waves decreased in the UC group when compared to the control group. LA mechanical functions were different between groups, except for left atrial (LA) maximal volume: LA minimum volume (22.2 ± 12.9 vs. 15.3 ± 4.7, P = 0.001), LA volume before atrial systole (29.9 ± 14.2 vs. 24.2 ± 4.9, P = 0.021), LA ejection fraction (27.4 ± 16.5 vs. 38.6 ± 10.1, P < 0.001), LA total emptying volume (17.9 ± 6.9 vs. 21.9 ± 5.9, P = 0.004), LA active emptying fraction (27.4 ± 16.5 vs. 38.6 ± 10.1, P < 0.001), LA active emptying volume (7.7 ± 3.6 vs. 9.4 ± 2.9, P = 0.013), LA passive emptying fraction (26.8 ± 10.2 vs. 33.2 ± 9.2, P = 0.002), and LA passive emptying volume (10.3 ± 4.9 vs. 12.5 ± 4.5, P = 0.029). There was a significant difference between the groups in terms of AEMD durations, except time interval from the onset of the P-wave on the surface ECG to the peak of the late diastolic wave (PA) of the tricuspid valve. The correlation analysis revealed that age and duration of disease were correlated with AEMD. CONCLUSION The current study reported that LA volume and mechanical functions degenerated and AEMD increased in patients with UC when compared to the control group. These findings demonstrate that UC may have effects on LA electromechanical functions related to duration of disease.
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Affiliation(s)
- Gokay Nar
- Department of Cardiology, Faculty of Medicine, Ahi Evran University, Kirsehir, Turkey
| | - Bilal Ergul
- Department of Gastroenterology, Ahi Evran University Education and Research Hospital, Kirsehir, Turkey
| | - Gokhan Aksan
- Department of Cardiology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Sinan Inci
- Department of Cardiology, Aksaray State hospital, Aksaray, Turkey
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Aksu F, Karadag AS, Caliskan M, Uzuncakmak TK, Keles N, Ozlu E, Yilmaz Y, Akdeniz N. Does Lichen Planus Cause Increased Carotid Intima-Media Thickness and Impaired Endothelial Function? Can J Cardiol 2016; 32:1246.e1-6. [PMID: 26948036 DOI: 10.1016/j.cjca.2015.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 11/12/2015] [Accepted: 11/12/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lichen planus (LP) has been associated with cardiovascular disease (CVD) risk factors, but there are no studies on the association between LP and subclinical atherosclerosis. We investigated the presence of subclinical atherosclerosis in patients with LP not known to have CVD using carotid intima-media thickness (CIMT) and flow-mediated dilatation (FMD). METHODS The study included 30 patients with LP and 30 controls. High-resolution ultrasonography was used to assess CIMT and FMD. Participants' biochemical parameters, body mass index (BMI), and waist circumference were recorded in both groups. RESULTS FMD was significantly lower (7.45% ± 3.63% vs 11.01% ± 5.34%; P = 0.004) and CIMT was higher (0.8 mm [range, 0.7-0.9 mm] vs 0.6 mm [0.4-0.6 mm]; P < 0.001) in the LP group compared with the control group. After adjustment for age, sex, BMI, high-density lipoprotein cholesterol levels, and C-reactive protein levels, the presence of LP was associated with impairment of FMD (β = -0.441; 95% CI, -9.336 to -0.321; P = 0.037) and an increase in CIMT (β = 0.459; 95% CI, 0.057 to -0.351; P = 0.008). CONCLUSIONS Reduced FMD and increased CIMT levels are sensitive indicators of target-organ damage and display increased risk for cardiovascular morbidity and mortality. Our study found that patients with LP showed a tendency toward impaired levels of FMD and increased CIMT. LP may be a novel predictor of early vascular dysfunction and structural changes.
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Raphael R, Purushotham D, Gastonguay C, Chesnik MA, Kwok WM, Wu HE, Shah SJ, Mirza SP, Strande JL. Combining patient proteomics and in vitro cardiomyocyte phenotype testing to identify potential mediators of heart failure with preserved ejection fraction. J Transl Med 2016; 14:18. [PMID: 26792056 PMCID: PMC4719542 DOI: 10.1186/s12967-016-0774-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 01/06/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Heart failure with ejection fraction (HFpEF) is a syndrome resulting from several co-morbidities in which specific mediators are unknown. The platelet proteome responds to disease processes. We hypothesize that the platelet proteome will change composition in patients with HFpEF and may uncover mediators of the syndrome. METHODS AND RESULTS Proteomic changes were assessed in platelets from hospitalized subjects with symptoms of HFpEF (n = 9), the same subjects several weeks later without symptoms (n = 7) and control subjects (n = 8). Mass spectrometry identified 6102 proteins with five scans with peptide probabilities of ≥0.85. Of the 6102 proteins, 165 were present only in symptomatic subjects, 78 were only found in outpatient subjects and 157 proteins were unique to the control group. The S100A8 protein was identified consistently in HFpEF samples when compared with controls. We validated the fining that plasma S100A8 levels are increased in subjects with HFpEF (654 ± 391) compared to controls (352 ± 204) in an external cohort (p = 0.002). Recombinant S100A8 had direct effects on the electrophysiological and calcium handling profile in human induced pluripotent stem cell-derived cardiomyocytes. CONCLUSIONS Platelets may harbor proteins associated with HFpEF. S100A8 is present in the platelets of subjects with HFpEF and increased in the plasma of the same subjects. We further established a bedside-to-bench translational system that can be utilized as a secondary screen to ascertain whether the biomarkers may be an associated finding or causal to the disease process. S100A8 has been linked with other cardiovascular disease such as atherosclerosis and risk for myocardial infarction, stroke, or death. This is the first report on association of S100A8 with HFpEF.
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Affiliation(s)
- Roseanne Raphael
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Diana Purushotham
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Courtney Gastonguay
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA. .,Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. .,Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Marla A Chesnik
- Biotechnology and Bioengineering, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Wai-Meng Kwok
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Hsiang-En Wu
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Shama P Mirza
- Biotechnology and Bioengineering, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Jennifer L Strande
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA. .,Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. .,Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. .,, MEB/CVC 4579, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
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Caliskan M, Turk E, Karagulle E, Ciftci O, Oguz H, Kostek O, Moray G, Haberal M. Coronary Flow Velocity Reserve in Burn Injury: A Prospective Clinical Cohort Study. J Burn Care Res 2016; 37:e400-8. [PMID: 26284645 DOI: 10.1097/BCR.0000000000000302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The authors sought to evaluate coronary microvascular function and left ventricular diastolic dysfunction using transthoracic Doppler echocardiography in burn patients. In this study, 32 adult burn patients with partial or full-thickness scald burns that were hospitalized and treated were included. The control group was matched for age and sex and was composed of otherwise healthy volunteers. Transthoracic Doppler echocardiography examinations and simultaneous laboratory tests for cardiac evaluation were performed on the sixth month after burn injury as well as with the control group. High-sensitivity C-reactive protein levels were significantly higher in the burn patients than in controls (5.17 ± 3.86 vs 2.42 ± 1.78; P = .001). Lateral isovolumic relaxation time was significantly higher in the burn injury group than in the control group (92.7 ± 15.7 vs 85.5 ± 8.3; P = .03). Baseline coronary diastolic peak flow velocity of the left anterior descending artery was similar in both groups. However, hyperemic diastolic peak flow velocity and coronary flow velocity reserve (2.26 ± 0.48 vs 2.94 ± 0.47; P < .001) were significantly lower in the burn injury group than in the control group. Coronary flow velocity reserve was significantly and inversely correlated with high-sensitivity C-reactive protein, burn ratio, creatinine, and mitral A-wave max velocity. At the sixth month of treatment, burn patients had high-sensitivity C-reactive protein levels during this period, suggesting that inflammation still exists. In addition, subclinical coronary microvascular and left ventricular diastolic dysfunction can occur in burn patients without traditional cardiovascular risk factors. However, these results must be supported by additional studies.
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Keles N, Caliskan M, Aksu FU, Keles NN, Karagoz V, Tekin AS, Akcakoyun M, Kostek O, Elcioglu O, Aung SM, Bakan A, Odabas AR. Retrobulbar blood flow and carotid intima–media thickness alteration may relate to subclinic atherosclerosis in patients with chronic inflammatory diseases. Ren Fail 2015; 37:1164-70. [DOI: 10.3109/0886022x.2015.1057469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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