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[Myocardial perfusion under H.E.L.P. -apheresis. Objectification by PET]
K-P Mellwig1, D Baller, H K Schmidt
1Herz- und Diabeteszentrum NRW, Kardiologische Klinik, Georgstr. 11, 32545 Bad Oeynhausen, Germany. kpmellwig@hdz-nrw.de
Zeitschrift Fur Kardiologie
|December 10, 2003
Summary
LDL apheresis rapidly improves coronary vasodilation in hypercholesterolemia patients. This rapid improvement in endothelial function occurs within 20 hours, challenging previous assumptions about cholesterol-lowering therapy onset.
Area of Science:
- Cardiology
- Vascular Biology
- Medical Imaging
Background:
- Endothelial dysfunction (ED) in hypercholesterolemia reduces coronary vasodilation capacity.
- Cholesterol lowering can restore endothelial function, but the therapeutic effect onset is traditionally considered slow (weeks to months).
- Lipoprotein apheresis offers rapid and significant reduction of low-density lipoprotein (LDL) cholesterol within hours.
Purpose of the Study:
- To investigate the immediate impact of LDL apheresis on coronary vasodilation capacity.
- To assess changes in myocardial blood flow and coronary flow reserve shortly after LDL apheresis.
- To challenge the established timeline for therapeutic effects of cholesterol reduction on endothelial function.
Main Methods:
- Positron emission tomography (PET) with N13 ammonia was used for dynamic quantitative myocardial perfusion imaging.
- 35 patients with coronary heart disease and hypercholesterolemia underwent PET scans before and 18-20 hours after LDL apheresis.
- Measurements included myocardial blood flow at rest and during dipyridamole-induced vasodilation, coronary flow reserve, and minimal coronary resistance.
Main Results:
- LDL apheresis significantly reduced LDL cholesterol (175 to 77 mg/dl) and fibrinogen (287 to 155 mg/dl).
- A significant improvement in myocardial blood flow under dipyridamole (177 to 217 ml/min/100g) and coronary flow reserve (2.10 to 2.62) was observed.
- Minimal coronary resistance decreased significantly (0.56 to 0.44 mmHg*100g*min/ml), indicating improved vasodilation within 20 hours.
Conclusions:
- A single LDL apheresis session rapidly improves coronary vasodilation capacity by approximately 20% within 20 hours.
- These findings demonstrate a much faster onset of therapeutic effect on endothelial function than previously assumed.
- Rapid LDL reduction via apheresis provides a potential strategy for quickly improving coronary hemodynamics in hypercholesterolemia.