Öz
Kaynakça
- 1. Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness on survival in end-stage renal disease. Circulation 1999;99:2434-9.
- 2. Ben-Shlomo Y, Spears M, Boustred C, et al. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol 2014;63:636-46.
- 3. Ohtsuka S, Kakihana M, Watanabe H, Sugishita Y. Chronically decreased aortic distensibility causes deterioration of coronary perfusion during increased left ventricular contraction. J Am Coll Cardiol 1994;24:1406-14.
- 4. Saito M, Okayama H, Nishimura K, et al. Possible link between large artery stiffness and coronary flow velocity reserve. Heart 2008;94:e20.
- 5. Watanabe H, Ohtsuka S, Kakihana M, Sugishita Y. Coronary circulation in dogs with an experimental decrease in aortic compliance. J Am Coll Cardiol 1993;21:1497-506.
- 6. Caiati C, Montaldo C, Zedda N, Bina A, Iliceto S. New noninvasive method for coronary flow reserve assessment: contrast-enhanced transthoracic second harmonic echo Doppler. Circulation 1999;99:771-8.
- 7. Chamuleau SA, Siebes M, Meuwissen M, Koch KT, Spaan JA, Piek JJ. Association between coronary lesion severity and distal microvascular resistance in patients with coronary artery disease. Am J Physiol Heart Circ Physiol 2003;285:H2194-200.
- 8. Laurent S, Cockcroft J, Van Bortel L, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006;27:2588-605.
- 9. Ommen SR, Nishimura RA, Appleton CP, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: A comparative simultaneous Doppler-catheterization study. Circulation 2000;102:1788-94.
- 10. Chemla D, Nitenberg A, Teboul JL, et al. Subendocardial viability index is related to the diastolic/systolic time ratio and left ventricular filling pressure, not to aortic pressure: an invasive study in resting humans. Clin Exp Pharmacol Physiol 2009;36:413-8.
- 11. Salvi P. Pulse waves : how vascular hemodynamics affects blood pressure. New York Dordrecht London: Springer Milan Heidelberg; 2016.
- 12. Aslanger E, Assous B, Bihry N, Beauvais F, Logeart D, Cohen-Solal A. Effects of Cardiopulmonary Exercise Rehabilitation on Left Ventricular Mechanical Efficiency and Ventricular-Arterial Coupling in Patients With Systolic Heart Failure. J Am Heart Assoc 2015;4:e002084.
- 13. Cortigiani L, Rigo F, Galderisi M, et al. Diagnostic and prognostic value of Doppler echocardiographic coronary flow reserve in the left anterior descending artery in hypertensive and normotensive patients [corrected]. Heart 2011;97:1758-65.
- 14. McDonald DA, Nichols WW, O'Rourke MF, Hartley C. McDonald's blood flow in arteries : theoretic, experimental, and clinical principles. London; New York: Arnold ; Oxford University Press; 1997.
- 15. Mitchell GF, van Buchem MA, Sigurdsson S, et al. Arterial stiffness, pressure and flow pulsatility and brain structure and function: the Age, Gene/Environment Susceptibility--Reykjavik study. Brain 2011;134:3398-407.
- 16. Westerhof N, Stergiopulos N, Noble MI. Snapshots of hemodynamics: an aid for clinical research and graduate education: Springer Science & Business Media; 2010.
- 17. Knaapen P, Camici PG, Marques KM, et al. Coronary microvascular resistance: methods for its quantification in humans. Basic Res Cardiol 2009;104:485-98.
- 18. Rizzoni D, Porteri E, Guelfi D, et al. Structural alterations in subcutaneous small arteries of normotensive and hypertensive patients with non-insulin-dependent diabetes mellitus. Circulation 2001;103:1238-44.
- 19. Iozzo P, Chareonthaitawee P, Di Terlizzi M, Betteridge DJ, Ferrannini E, Camici PG. Regional myocardial blood flow and glucose utilization during fasting and physiological hyperinsulinemia in humans. Am J Physiol Endocrinol Metab 2002;282:E1163-71.
- 20. Quinones MJ, Hernandez-Pampaloni M, Schelbert H, et al. Coronary vasomotor abnormalities in insulin-resistant individuals. Ann Intern Med 2004;140:700-8.
- 21. Safar ME, Rizzoni D, Blacher J, Muiesan ML, Agabiti-Rosei E. Macro and microvasculature in hypertension: therapeutic aspects. J Hum Hypertens 2008;22:590-5.
Relation Between Microvascular and Macrovascular Hemodynamics in Normal Epicardial Coronary Arteries
Öz
Introduction: Cardiovascular risk factors both affect macrovascular and microvascular systems, resulting in negative results on the entire vascular tree. Aortic stiffness causes augmented systolic pressure, increased pulse pressure, increased myocardial oxygen demand, and consequently, coronary blood flow diminishes because of decreased diastolic augmentation. The aim of our study is to investigate the relation between macrovascular and microvascular hemodynamics.
Methods: We have included 58 consecutive patients (29 male, age 54[34-71]) without any epicardial coronary stenosis in coronary angiography. Macrovascular and microvascular parameters were calculated with the measurements of tonometry, coronary flow reserve, and microvascular resistance.
Results:Carotid-femoral pulse wave velocity (PWV) and subendocardial viability ratio (SEVR) had an inverse correlation (r=-0.328,p=0.007).The main reason of this correlation was priorly positive correlation between PWV and systolic pressure-time integral (SPTI) (r=0.465, p<0.001).A positive correlation was noted between augmentation index (AI) and PWV (r=0.352,p=0.010); and an inverse significant correlation was noted between AI and SEVR (r=-0.383,p=0.003).PWV had a positive correlation with diastolic/systolic coronary flow velocity (r=0.42,p=0.04) and microvascular resistance (MR) (r=0.44,p=0.03) and a negative correlation with hyperemic mean coronary flow velocity (r=-0.416,p=0.043) and coronary flow reserve (CFR) (r=-0.419,p=0.04) in diabetic patient group (n=27).AI was inversely related to CFR (r=-0.41,p=0.04) in diabetic patient group.SEVR and CFR were well correlated in the same direction (r=0.569, p<0.001).SEVR was significantly lower in the patients with lower CFR (1.41±0.23/1.58±0.24,p=0.01).SEVR had a significant negative correlation with MR (r=-0.321,p=0.016). SEVR was associated with arteriolar resistance index (r=0.413,p=0.002).
Conclusion: Cardiovascular events appear as a combined result of the pathologies of the macro and microvascular levels. Aortic wall pathologies, which affect central hemodynamic properties, change subendocardial perfusion and coronary microcirculation.
Anahtar Kelimeler
pulse wave velocity augmentation index subendocardial viability ratio index of microvascular resistance coronary flow reserve normal coronary arteries microvascular dysfunction
Kaynakça
- 1. Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness on survival in end-stage renal disease. Circulation 1999;99:2434-9.
- 2. Ben-Shlomo Y, Spears M, Boustred C, et al. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol 2014;63:636-46.
- 3. Ohtsuka S, Kakihana M, Watanabe H, Sugishita Y. Chronically decreased aortic distensibility causes deterioration of coronary perfusion during increased left ventricular contraction. J Am Coll Cardiol 1994;24:1406-14.
- 4. Saito M, Okayama H, Nishimura K, et al. Possible link between large artery stiffness and coronary flow velocity reserve. Heart 2008;94:e20.
- 5. Watanabe H, Ohtsuka S, Kakihana M, Sugishita Y. Coronary circulation in dogs with an experimental decrease in aortic compliance. J Am Coll Cardiol 1993;21:1497-506.
- 6. Caiati C, Montaldo C, Zedda N, Bina A, Iliceto S. New noninvasive method for coronary flow reserve assessment: contrast-enhanced transthoracic second harmonic echo Doppler. Circulation 1999;99:771-8.
- 7. Chamuleau SA, Siebes M, Meuwissen M, Koch KT, Spaan JA, Piek JJ. Association between coronary lesion severity and distal microvascular resistance in patients with coronary artery disease. Am J Physiol Heart Circ Physiol 2003;285:H2194-200.
- 8. Laurent S, Cockcroft J, Van Bortel L, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006;27:2588-605.
- 9. Ommen SR, Nishimura RA, Appleton CP, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: A comparative simultaneous Doppler-catheterization study. Circulation 2000;102:1788-94.
- 10. Chemla D, Nitenberg A, Teboul JL, et al. Subendocardial viability index is related to the diastolic/systolic time ratio and left ventricular filling pressure, not to aortic pressure: an invasive study in resting humans. Clin Exp Pharmacol Physiol 2009;36:413-8.
- 11. Salvi P. Pulse waves : how vascular hemodynamics affects blood pressure. New York Dordrecht London: Springer Milan Heidelberg; 2016.
- 12. Aslanger E, Assous B, Bihry N, Beauvais F, Logeart D, Cohen-Solal A. Effects of Cardiopulmonary Exercise Rehabilitation on Left Ventricular Mechanical Efficiency and Ventricular-Arterial Coupling in Patients With Systolic Heart Failure. J Am Heart Assoc 2015;4:e002084.
- 13. Cortigiani L, Rigo F, Galderisi M, et al. Diagnostic and prognostic value of Doppler echocardiographic coronary flow reserve in the left anterior descending artery in hypertensive and normotensive patients [corrected]. Heart 2011;97:1758-65.
- 14. McDonald DA, Nichols WW, O'Rourke MF, Hartley C. McDonald's blood flow in arteries : theoretic, experimental, and clinical principles. London; New York: Arnold ; Oxford University Press; 1997.
- 15. Mitchell GF, van Buchem MA, Sigurdsson S, et al. Arterial stiffness, pressure and flow pulsatility and brain structure and function: the Age, Gene/Environment Susceptibility--Reykjavik study. Brain 2011;134:3398-407.
- 16. Westerhof N, Stergiopulos N, Noble MI. Snapshots of hemodynamics: an aid for clinical research and graduate education: Springer Science & Business Media; 2010.
- 17. Knaapen P, Camici PG, Marques KM, et al. Coronary microvascular resistance: methods for its quantification in humans. Basic Res Cardiol 2009;104:485-98.
- 18. Rizzoni D, Porteri E, Guelfi D, et al. Structural alterations in subcutaneous small arteries of normotensive and hypertensive patients with non-insulin-dependent diabetes mellitus. Circulation 2001;103:1238-44.
- 19. Iozzo P, Chareonthaitawee P, Di Terlizzi M, Betteridge DJ, Ferrannini E, Camici PG. Regional myocardial blood flow and glucose utilization during fasting and physiological hyperinsulinemia in humans. Am J Physiol Endocrinol Metab 2002;282:E1163-71.
- 20. Quinones MJ, Hernandez-Pampaloni M, Schelbert H, et al. Coronary vasomotor abnormalities in insulin-resistant individuals. Ann Intern Med 2004;140:700-8.
- 21. Safar ME, Rizzoni D, Blacher J, Muiesan ML, Agabiti-Rosei E. Macro and microvasculature in hypertension: therapeutic aspects. J Hum Hypertens 2008;22:590-5.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Original Articles |
| Yazarlar | |
| Yayımlanma Tarihi | 29 Ekim 2021 |
| Gönderilme Tarihi | 2 Şubat 2021 |
| Kabul Tarihi | 29 Mayıs 2021 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 3 Sayı: 4 |
