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Impaired coronary flow velocity reserve and aortic distensibility in patients with untreated hypercholesterolemia--an
Attila Nemes1, Tamás Forster, Miklós Csanády
1Medical Faculty, 2nd Department of Medicine and Cardiology Center, Albert Szent-Györgyi Medical and Pharmaceutical Center, University of Szeged, Korányi fasor 6, P.O. Box 427, H-6720, Szeged, Hungary. nemes@in2nd.szote.u-szeged.hu
Insights
Hypercholesterolemia impairs coronary flow reserve (CFR) and aortic distensibility. These key indicators of cardiovascular health can be measured simultaneously using stress transesophageal echocardiography (TEE) in patients with high cholesterol.
Area of Science:
- Cardiovascular Physiology
- Medical Imaging
- Biomedical Engineering
Background:
- Hypercholesterolemia is a major risk factor for atherosclerosis, coronary artery disease (CAD), and aortic atherosclerosis (AA).
- Assessing aortic distensibility and coronary flow velocity reserve (CFR) provides insights into cardiovascular health.
- Transesophageal echocardiography (TEE) is a valuable tool for cardiac assessment.
Purpose of the Study:
- To measure aortic distensibility indices (elastic modulus E(p) and Young's static elastic modulus E(s)) and CFR.
- To compare these measures in untreated hypercholesterolemic (HC) patients versus normocholesterolemic (NC) subjects.
- To evaluate the feasibility of simultaneous measurement during stress TEE.
Main Methods:
- Comparison of three groups: NC subjects, HC patients with negative coronary angiograms, and HC patients with significant left anterior descending (LAD) coronary artery disease.
- All participants underwent coronary angiography, transthoracic echocardiography, and stress TEE.
- Measurement of E(p), E(s), and CFR.
Main Results:
- CFR was significantly reduced in both HC groups compared to NC subjects.
- E(p) was significantly increased in HC patients (both groups) compared to NC subjects, with a further increase in those with LAD disease.
- E(s) showed a similar pattern of significant increase in HC patients compared to NC subjects.
Conclusions:
- Stress TEE allows for simultaneous evaluation of CFR and aortic distensibility indices in HC patients.
- Both CFR and aortic distensibility are impaired in hypercholesterolemic individuals compared to normocholesterolemic subjects.
- These findings highlight the subclinical vascular dysfunction associated with hypercholesterolemia.
Introduction:
Hypercholesterolemia is a primary risk factor for the development of atherosclerosis and leading to severe stages of coronary artery disease (CAD) and aortic atherosclerosis (AA). The objective of this investigation was to measure elastic modulus [(E(p), in 10(3) mmHg] and Young's circumferential static elastic modulus [(E(s), in 10(3) mmHg] as aortic distensibility indices and coronary flow velocity reserve (CFR) in untreated hypercholesterolemic (HC) patients in the course of the same stress transesophageal echocardiography (TEE) and to compare their results to normochole- sterolemic (NC) subjects.
Patients And Methods:
The following patient populations were compared: 17 NC subjects with negative coronary angiograms, 18 patients with untreated hypercholesterolemia with a negative coronary angiogram and 23 HC patients with significant left anterior descending coronary artery (LAD) disease. All patients underwent coronary angiography, transthoracic and stress TEE examinations.
Results:
CFR was significantly reduced in patients of both groups with hypercholesterolemia as compared to NC subjects (1.99+/-0.76 and 1.79+/-0.32 vs. 2.58+/-0.63, P<0.05, respectively). E(p) was significantly increased in HC patients with negative coronary angiograms as compared to NC subjects (0.39+/-0.18 vs. 0.67+/-0.19, P<0.05), while further increase was found in HC patients with LAD disease (0.67+/-0.19 vs. 1.09+/-0.52, P<0.05). E(s) behaved similarly (4.06+/-2.73 vs. 7.60+/-3.70 vs. 11.38+/-6.91, P<0.05, respectively).
Conclusion:
In conclusion it may be stated that CFR and aortic distensibility indices can be evaluated simultaneously by stress TEE in HC patients. CFR and aortic distensibility were impaired in HC patients as compared to NC subjects.
