10 research outputs found
Disminución de la reserva de flujo coronario en pacientes con insuficiencia cardíaca no isquémica
Introduction and objectives. Coronary flow reserve
(CFR) is impaired not only in ischemic heart disease, but
also in cardiac diseases that may or may not course with
heart failure. The aim of the present study was to determine
if the severity of heart failure can influence CFR impairment.
Methods. Forty patients with non-ischemic heart disease
and heart failure were studied 41 times. Four groups
were established: 1. 10 patients in functional class III-IV;
2. 10 patients in functional class II not taking beta-blockers;
3. 11 patients in class II treated with carvedilol, and 4.
10 patients in class I. These patients had a history of heart
failure and systolic dysfunction. Myocardial blood flow
(MBF) was measured with positron emission tomography
(PET) and N-13 ammonia at rest (r) and during adenosine
triphosphate (ATP) infusion.
Results. MBF and CFR were significantly higher in
group 4 (1.95 ± 0.58 and 2.40 ± 0.95 ml/min/g) than in
group 1 (1.02 ± 0.52 and 1.46 ± 0.48 ml/min/g). CFR tended
to be higher in groups 2 (1.73 ± 0.72), and 3 (1.89 ±
0.75) vs group 1. No significant correlation was found between
CFR and the following variables: age, systolic blood
pressure, ventricular mass index, ventricular volume indexes,
and ejection fraction.
Conclusions. Coronary microvascular function is impaired
in non-ischemic heart failure, and the impairment is
related to functional class, regardless of the underlying
responsible heart disease
Los pacientes con placas coronarias vulnerables presentan mayores niveles séricos de metaloproteinasa-1
Fundamento. Las placas ateroscleróticas que producen la
mayoría de los síndromes coronarios agudos al romperse son
los fibroateromas de cápsula fina, denominados placas vulnerables.
Éstas pueden ser detectadas únicamente con técnicas
invasivas de imagen intracoronaria. Es preciso encontrar un
biomarcador no invasivo que permita identificar a los pacientes
con estas placas sin necesidad de cateterismo cardiaco.
La metaloproteinasa-1 es una enzima involucrada en el metabolismo
de la matriz extracelular que ha sido relacionada con
la ruptura de las placas ateroscleróticas. Se desconocen sus
niveles séricos en pacientes con placas vulnerables.
Material y métodos. Se incluyeron pacientes sometidos a
cateterismo cardiaco por enfermedad coronaria estable. Se
estudiaron las arterias coronarias con tomografía de coherencia
óptica para detectar placas vulnerables. Se extrajeron
muestras de sangre periférica y del seno coronario para
analizar la concentración de metaloproteinasa-1.
Resultados. Se incluyeron 51 pacientes. Trece tenían al
menos un fibroateroma de cápsula fina. No se encontraron
diferencias significativas en las características clínicas,
perfil lipídico ni proteína C reactiva entre los pacientes
con y sin placas vulnerables. Los pacientes con placas vulnerables
presentaron concentraciones significativamente
mayores de metaloproteinasa-1, tanto en sangre periférica
(7330±5541 vs 2894±1783 pg/ml, p=0,025) como en seno coronario
(6012±3854 vs 2707±1252 pg/ml, p=0,047).
Conclusiones. Los pacientes con placas vulnerables presentaron
niveles séricos significativamente mayores de metaloproteinasa-
1. Se requieren estudios con seguimiento clínico para
evaluar el valor pronóstico de la metaloproteinasa-1 sérica
Characterization of coronary plaques with combined use of intravascular ultrasound, virtual histology and optical coherence tomography
According to post-mortem studies, luminal thrombosis occurs from plaque rupture, erosion and calcified nodules. In vivo studies have found thin cap fibroatheroma (TCFA) as the main vulnerable lesion, prone to rupture. Few data about other post-mortem lesions have been reported in vivo. Our main objective is to characterize in vivo the coronary plaques with intravascular ultrasound-virtual histology (IVUS-VH) and optical coherence tomography (OCT), in order to detect not only thin cap fibroatheroma (TCFA), but also other possible vulnerable lesions. The secondary objective is to correlate these findings with clinical and analytical data. Twenty-five patients (18 stable) submitted to coronary angiography were included in this pilot study. After angiography, the three vessels were studied (when possible) with IVUS-VH and OCT. Plaque characteristics were correlated with clinical and analytical data. Forty-six lesions were analyzed. IVUS-VH detected significant necrotic core in 15 (3 were definite TCFA). OCT detected TCFA in 10 lesions, erosion in 6, thrombus in 5 and calcified nodule in 8. Possible vulnerable lesion was found in 61% of stable and 57% of unstable patients. Erosions and calcified nodules were only found in stable patients. Those with significant necrotic core had higher body mass index (P=0.016), higher levels of hs-CRP (P=0.019) and triglycerides (P=0.040). The higher the levels of hs-CRP, the larger the size of the necrotic core (r=0.69, P=0.003). Lesions with characteristics of vulnerability were detected by IVUS-VH and OCT in more than 50% of stable and unstable coronary patients. A significant necrotic core was mainly correlated with higher hs-CRP
Los pacientes con placas coronarias vulnerables presentan mayores niveles séricos de metaloproteinasa-1
Fundamento. Las placas ateroscleróticas que producen la
mayoría de los síndromes coronarios agudos al romperse son
los fibroateromas de cápsula fina, denominados placas vulnerables.
Éstas pueden ser detectadas únicamente con técnicas
invasivas de imagen intracoronaria. Es preciso encontrar un
biomarcador no invasivo que permita identificar a los pacientes
con estas placas sin necesidad de cateterismo cardiaco.
La metaloproteinasa-1 es una enzima involucrada en el metabolismo
de la matriz extracelular que ha sido relacionada con
la ruptura de las placas ateroscleróticas. Se desconocen sus
niveles séricos en pacientes con placas vulnerables.
Material y métodos. Se incluyeron pacientes sometidos a
cateterismo cardiaco por enfermedad coronaria estable. Se
estudiaron las arterias coronarias con tomografía de coherencia
óptica para detectar placas vulnerables. Se extrajeron
muestras de sangre periférica y del seno coronario para
analizar la concentración de metaloproteinasa-1.
Resultados. Se incluyeron 51 pacientes. Trece tenían al
menos un fibroateroma de cápsula fina. No se encontraron
diferencias significativas en las características clínicas,
perfil lipídico ni proteína C reactiva entre los pacientes
con y sin placas vulnerables. Los pacientes con placas vulnerables
presentaron concentraciones significativamente
mayores de metaloproteinasa-1, tanto en sangre periférica
(7330±5541 vs 2894±1783 pg/ml, p=0,025) como en seno coronario
(6012±3854 vs 2707±1252 pg/ml, p=0,047).
Conclusiones. Los pacientes con placas vulnerables presentaron
niveles séricos significativamente mayores de metaloproteinasa-
1. Se requieren estudios con seguimiento clínico para
evaluar el valor pronóstico de la metaloproteinasa-1 sérica
Disminución de la reserva de flujo coronario en pacientes con insuficiencia cardíaca no isquémica
Introduction and objectives. Coronary flow reserve
(CFR) is impaired not only in ischemic heart disease, but
also in cardiac diseases that may or may not course with
heart failure. The aim of the present study was to determine
if the severity of heart failure can influence CFR impairment.
Methods. Forty patients with non-ischemic heart disease
and heart failure were studied 41 times. Four groups
were established: 1. 10 patients in functional class III-IV;
2. 10 patients in functional class II not taking beta-blockers;
3. 11 patients in class II treated with carvedilol, and 4.
10 patients in class I. These patients had a history of heart
failure and systolic dysfunction. Myocardial blood flow
(MBF) was measured with positron emission tomography
(PET) and N-13 ammonia at rest (r) and during adenosine
triphosphate (ATP) infusion.
Results. MBF and CFR were significantly higher in
group 4 (1.95 ± 0.58 and 2.40 ± 0.95 ml/min/g) than in
group 1 (1.02 ± 0.52 and 1.46 ± 0.48 ml/min/g). CFR tended
to be higher in groups 2 (1.73 ± 0.72), and 3 (1.89 ±
0.75) vs group 1. No significant correlation was found between
CFR and the following variables: age, systolic blood
pressure, ventricular mass index, ventricular volume indexes,
and ejection fraction.
Conclusions. Coronary microvascular function is impaired
in non-ischemic heart failure, and the impairment is
related to functional class, regardless of the underlying
responsible heart disease