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Evaluation of improved coronary flow velocity reserve using transthoracic Doppler echocardiography after single LDL
Kengo Kobayashi1, Kazuhito Yamashita, Hiromi Tasaki
1The 2nd Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
Insights
Single low-density lipoprotein (LDL) apheresis significantly improves coronary flow velocity reserve (CFVR) in patients with familial hypercholesterolemia. This improvement is linked to decreased baseline flow velocity and favorable changes in plasma markers.
Area of Science:
- Cardiology
- Vascular Biology
- Medical Technology
Background:
- Lipid-lowering therapy can enhance endothelial function in coronary vessels.
- Limited research exists on the impact of acute low-density lipoprotein (LDL) reduction on coronary flow velocity reserve (CFVR).
Purpose of the Study:
- To determine if single low-density lipoprotein (LDL) apheresis improves coronary flow velocity reserve (CFVR) evaluated by adenosine 5'-triphosphate-induced hyperemia.
- To investigate the effects of acute LDL reduction on coronary microvascular function.
Main Methods:
- Seven patients with familial hypercholesterolemia and coronary stenosis were enrolled.
- Coronary flow velocity reserve (CFVR) was assessed using transthoracic Doppler echocardiography (TTDE) before and after LDL apheresis.
- Measurements included averaged diastolic peak velocity (ADPV) during hyperemia and plasma levels of bradykinin, 6 keto PGF1alpha, fibrinogen, and plasma viscosity.
Main Results:
- Coronary flow velocity reserve (CFVR) increased significantly from 1.78 to 2.10 (P < 0.001) post-apheresis.
- Averaged diastolic peak velocity (ADPV) at baseline decreased, suggesting vasodilation.
- Plasma bradykinin and 6 keto PGF1alpha increased, while fibrinogen and plasma viscosity decreased.
Conclusions:
- Single LDL apheresis enhances coronary flow velocity reserve (CFVR) in patients with familial hypercholesterolemia.
- The improvement is attributed to decreased baseline flow velocity, likely due to epicardial artery dilation and improved microvessel function.
- Changes in plasma LDL cholesterol, bradykinin, and PGI2 levels contribute to the observed vascular improvements.
Unlabelled:
The purpose of this study was to clarify whether coronary flow velocity reserve (CFVR), evaluated by adenosine 5'-triphosphate-induced hyperemia, is improved by single low-density lipoprotein (LDL) apheresis. Lipid lowering therapy is known to improve endothelium-dependent vasodilatation in forearm or coronary resistant vessels. However, few reports have studied the effect of acute LDL reduction on CFVR.
Methods:
Seven patients with familial hypercholesterolemia and significant coronary stenosis except in the left anterior descending artery (LAD) were enrolled in this study. Coronary flow velocity reserve was estimated before and after LDL apheresis using transthoracic Doppler echocardiography (TTDE), which detects the flow velocity at the distal site of the LAD. Although the averaged diastolic peak velocity (ADPV) during ATP-induced hyperemia was similar before and after LDL apheresis, the ADPV at baseline decreased from 30.69 to 25.56 cm/s, resulting in an increased CFVR from 1.78 to 2.10 (P < 0.001). Plasma bradykinin and 6 keto PGF1alpha increased while fibrinogen and plasma viscosity decreased after apheresis. Single LDL apheresis improves CFVR according to TTDE analysis because of the decreasing ADPV at baseline, which is thought to be induced by epicardial coronary artery dilatation and improved microvessel function. This is the result of various factors, such as changes in plasma LDL cholesterol, bradykinin and PGI2 levels with LDL apheresis.
