Myocardial blood flow reserve is impaired in patients with aortic valve calcification and unobstructed epicardial coronary arteries

This source preferred by Ahmed Khattab

Authors: Nam, M., Khattab, A. et al.

Start date: 4 August 2016

Journal: Heart Lung and Circulation; August 2016 Volume 25, Supplement 2, S1-S334

Volume: 25

Issue: S2

Pages: 243

Publisher: ELSEVIER

Introduction: Although coronary atherosclerosis is associated with calcific aortic valve disease (CAVD), it is not known whether they share pathophysiological mechanisms in early disease.

Aims: To investigate the relationship between myocardial blood flow reserve (MBFR) - a measure of coronary microcirculatory function, and early CAVD. We also determined whether this relationship was independent of coronary artery disease (CAD) and hs-CRP, a marker of systemic inflammation.

Methods&Results: 183 patients with chest pain and unobstructed coronary arteries were recruited. AVCS, coronary total plaque length (TPL), and coronary calcium score were quantified from multislice CT. MBFR was assessed using vasodilator myocardial contrast echocardiography. Inflammatory markers were obtained from venous sampling.

Mean age was 59.8 years, with 52.5% being male. The mean AVCS was 68AU (SD 258). Mean TPL was 15.6mm, and median coronary calcification score was 43.5AU. The mean MBFR was 2.20 (SD 0.52). Mean hs-CRP was 2.52mg/L (SD 3.86), with 59% participants having normal hs-CRP levels. Multivariate linear regression modelling incorporating demographics, coronary plaque characteristics, MBFR, and inflammatory markers, demonstrated that age (_=+0.05, CI:+0.02,+0.08, P=0.007), hs-CRP (_=+0.09, CI:+0.02,+0.16, P=0.010) and presence of diabetes (_=+1.03, CI:+0.08,+1.98, P=0.033), were positively associated with AVCS. In contrast, MBFR (_=-0.87, CI:-1.44,-0.30, P=0.003), body mass index (_=-0.11, CI:-0.21,-0.01, P=0.033), and LDL cholesterol (_=- 0.32, CI:-0.61,-0.03, P=0.029) were negatively associated with AVCS. TPL and coronary calcium score became insignificant when included in multivariate analysis.

Conclusions: MBFR is an independent predictor of aortic valve calcification and this effect is independent of the presence of CAD and also systemic inflammation.

This data was imported from PubMed:

Authors: Nel, K., Khattab, A. et al.

Journal: Int J Cardiol

Volume: 248

Pages: 427-432

eISSN: 1874-1754

DOI: 10.1016/j.ijcard.2017.06.023

BACKGROUND: Although calcific aortic valve disease (CAVD) is associated with coronary atherosclerosis, it is not known whether early CAVD is associated with coronary microcirculatory dysfunction (CMD). We sought to investigate the relationship between myocardial blood flow reserve (MBFR) - a measure of CMD, and early CAVD in the absence of obstructive epicardial coronary artery disease. We also determined whether this relationship was independent of coronary artery disease (CAD) and hs-CRP, a marker of systemic inflammation. METHODS: 183 patients with chest pain and unobstructed coronary arteries were studied. Aortic valve calcification score (AVCS), coronary total plaque length (TPL), and coronary calcium score were quantified from multislice CT. MBFR was assessed using vasodilator myocardial contrast echocardiography. Hs-CRP was measured from venous blood using a particle-enhanced immunoassay. RESULTS: Mean (±SD) participant age was 59.8 (9.6) years. Mean AVCS was 68 (258) AU, TPL was 15.6 (22.2) mm, and median coronary calcification score was 43.5AU. Mean MBFR was 2.20 (0.52). Mean hs-CRP was 2.52 (3.86) mg/l. Multivariable linear regression modelling incorporating demographics, coronary plaque characteristics, MBFR, and inflammatory markers, demonstrated that age (β=0.05, 95% CI: 0.02, 0.08, P=0.007), hs-CRP (β=0.09, CI: 0.02, 0.16, P=0.010) and diabetes (β=1.03, CI: 0.08, 1.98, P=0.033), were positively associated with AVCS. MBFR (β=-0.87, CI: -1.44, -0.30, P=0.003), BMI (β=-0.11, CI: -0.21, -0.01, P=0.033), and LDL (β=-0.32, CI: -0.61, -0.03, P=0.029) were negatively associated with AVCS. TPL and coronary calcium score were not independently associated with AVCS when included in the regression model. CONCLUSION: Coronary microvascular function as determined by measurement of myocardial blood flow reserve is independently associated with early CAVD. This effect is independent of the presence of coronary artery disease and also systemic inflammation.

This data was imported from Scopus:

Authors: Nel, K., Khattab, A. et al.

Journal: International Journal of Cardiology

Volume: 248

Pages: 427-432

eISSN: 1874-1754

ISSN: 0167-5273

DOI: 10.1016/j.ijcard.2017.06.023

© 2017 Elsevier B.V. Background Although calcific aortic valve disease (CAVD) is associated with coronary atherosclerosis, it is not known whether early CAVD is associated with coronary microcirculatory dysfunction (CMD). We sought to investigate the relationship between myocardial blood flow reserve (MBFR) - a measure of CMD, and early CAVD in the absence of obstructive epicardial coronary artery disease. We also determined whether this relationship was independent of coronary artery disease (CAD) and hs-CRP, a marker of systemic inflammation. Methods 183 patients with chest pain and unobstructed coronary arteries were studied. Aortic valve calcification score (AVCS), coronary total plaque length (TPL), and coronary calcium score were quantified from multislice CT. MBFR was assessed using vasodilator myocardial contrast echocardiography. Hs-CRP was measured from venous blood using a particle-enhanced immunoassay. Results Mean (± SD) participant age was 59.8 (9.6) years. Mean AVCS was 68 (258) AU, TPL was 15.6 (22.2) mm, and median coronary calcification score was 43.5 AU. Mean MBFR was 2.20 (0.52). Mean hs-CRP was 2.52 (3.86) mg/l. Multivariable linear regression modelling incorporating demographics, coronary plaque characteristics, MBFR, and inflammatory markers, demonstrated that age (β = 0.05, 95% CI: 0.02, 0.08, P = 0.007), hs-CRP (β = 0.09, CI: 0.02, 0.16, P = 0.010) and diabetes (β = 1.03, CI: 0.08, 1.98, P = 0.033), were positively associated with AVCS. MBFR (β = − 0.87, CI: − 1.44, − 0.30, P = 0.003), BMI (β = − 0.11, CI: − 0.21, − 0.01, P = 0.033), and LDL (β = − 0.32, CI: − 0.61, − 0.03, P = 0.029) were negatively associated with AVCS. TPL and coronary calcium score were not independently associated with AVCS when included in the regression model. Conclusion Coronary microvascular function as determined by measurement of myocardial blood flow reserve is independently associated with early CAVD. This effect is independent of the presence of coronary artery disease and also systemic inflammation.

This data was imported from Web of Science (Lite):

Authors: Nel, K., Khattab, A. et al.

Journal: INTERNATIONAL JOURNAL OF CARDIOLOGY

Volume: 248

Pages: 427-432

eISSN: 1874-1754

ISSN: 0167-5273

DOI: 10.1016/j.ijcard.2017.06.023

The data on this page was last updated at 05:09 on February 24, 2020.