Susceptibility to ischaemic heart disease: Focusing on genetic variants for ATP-sensitive potassium channel beyond traditional risk factors

2020 ◽  
pp. 204748732092678 ◽  
Author(s):  
Paolo Severino ◽  
Andrea D’Amato ◽  
Lucrezia Netti ◽  
Mariateresa Pucci ◽  
Marco V Mariani ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Ischaemic Heart Disease ◽  
Genetic Variants ◽  
Protective Factor ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Artery Disease

Aims Ischaemic heart disease is classically associated with coronary artery disease. Recent evidences showed the correlation between coronary microvascular dysfunction and ischaemic heart disease, even independently of coronary artery disease. Ion channels represent the final effectors of blood flow regulation mechanisms and their genetic variants, in particular of Kir6.2 subunit of the ATP-sensitive potassium channel (KATP), are reported to be involved in ischaemic heart disease susceptibility. The aim of the present study is to evaluate the role of KATP channel and its genetic variants in patients with ischaemic heart disease and evaluate whether differences exist between coronary artery disease and coronary microvascular dysfunction. Methods A total of 603 consecutive patients with indication for coronary angiography due to suspected myocardial ischaemia were enrolled. Patients were divided into three groups: coronary artery disease (G1), coronary microvascular dysfunction (G2) and normal coronary arteries (G3). Analysis of four single nucleotide polymorphisms (rs5215, rs5216, rs5218 and rs5219) of the KCNJ11 gene encoding for Kir6.2 subunit of the KATP channel was performed. Results rs5215 A/A and G/A were significantly more represented in G1, while rs5215 G/G was significantly more represented in G3, rs5216 G/G and C/C were both more represented in G3, rs5218 C/C was more represented in G1 and rs5219 G/A was more represented in G1, while rs5219 G/G was significantly more represented in G2. At multivariate analysis, single nucleotide polymorphism rs5215_G/G seems to represent an ischaemic heart disease independent protective factor. Conclusions These results suggest the potential role of KATP genetic variants in ischaemic heart disease susceptibility, as an independent protective factor. They may lead to a future perspective for gene therapy against ischaemic heart disease.

The coronary microcirculation and coronary microvascular dysfunction

2021 ◽  
pp. 18-21
Author(s):  
Romana Herscovici ◽  
C. Noel Bairey Merz
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Signs And Symptoms ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Microvascular Angina ◽  
Cardiac Syndrome ◽  
Artery Disease

The role of revascularization in the treatment of obstructive coronary artery disease is well established, and its impact on improving survival has been proven. Nevertheless, patients with signs and symptoms considered of cardiac origin but with no obstructive coronary artery disease on coronary angiography are increasingly seen. Initially described as a ‘paradox’ or cardiac syndrome X and subsequently defined as microvascular angina, angina-like chest pain and evidence of ischaemia with non-obstructive coronary artery disease, is the consequence of altered coronary microvascular response to various stimuli despite non-obstructed epicardial vessels.

scholarly journals The Role of Mental Stress in Ischaemia with No Obstructive Coronary Artery Disease and Coronary Vasomotor Disorders

2021 ◽  
Vol 16 ◽  
Author(s):  
Roos ET van der Meer ◽  
Angela HEM Maas
Keyword(s):  
Coronary Artery Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Psychological Stress ◽  
Myocardial Ischaemia ◽  
Mental Stress ◽  
Obstructive Coronary Artery Disease ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Artery Disease

Ischaemic heart disease has been estimated to affect 126.5 million people globally. Approximately 70% of patients with angina and suspected myocardial ischaemia show no signs of obstructed coronary arteries after coronary angiography, but may still demonstrate ischaemia. Ischaemia with no obstructive coronary artery disease (INOCA) is increasingly acknowledged as a serious condition because of its association with poor quality of life and elevated risk for cardiovascular events. The negative effects of psychological stress on INOCA are gaining more attention. Psychological stress is associated with adverse cardiovascular outcomes such as mental stress-induced myocardial ischaemia. Psychological stress includes anxiety, depression, anger and personality disturbances. Coronary microvascular dysfunction and coronary arterial spasm are phenotypes of coronary vasomotor disorders that are triggered by psychological distress and depression, thereby increasing cardiovascular disease risk. Coronary vasomotor disorders are often co-existent in INOCA patients and might be considered as a contributing factor to mental stress-associated adverse cardiovascular outcomes. Additionally, psychological stress induces endothelial dysfunction more often in (young) women with INOCA than in men. Overall, many studies demonstrate an association between mental stress, coronary microvascular dysfunction and coronary vasospasm in patients with INOCA – especially women. Future research on stress-reducing therapies that target coronary vasomotor disorders in patients with INOCA is needed. This is particularly the case in young adolescents, in whom this type of ischaemic heart disease is increasing.

scholarly journals Elevated C-reactive protein levels and coronary microvascular dysfunction in patients with coronary artery disease

2005 ◽  
Vol 26 (20) ◽  
pp. 2099-2105 ◽  
Author(s):  
Fabrizio Tomai ◽  
Flavio Ribichini ◽  
Anna S. Ghini ◽  
Valeria Ferrero ◽  
Giuseppe Andò ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
C Reactive Protein ◽  
Protein Levels ◽  
Reactive Protein ◽  
Artery Disease

Abstract 14277: Serum Nt-prob-type Natriuretic Peptide is Associated With Coronary Microvascular Dysfunction in Patients With Angina and Non-obstructive Coronary Artery Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ali Ahmad ◽  
Jaskanwal D Sara ◽  
Michel T Corban ◽  
Takumi Toya ◽  
Ilke Ozcan ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Natriuretic Peptide ◽  
Obstructive Coronary Artery Disease ◽  
Inverse Correlation ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Flow Reserve ◽  
Artery Disease ◽  
And Gender

Title: Serum NT-proB-type Natriuretic Peptide is associated with Coronary Microvascular Dysfunction in Patients with Angina and Non-obstructive Coronary Artery Disease Authors: Ali Ahmad, MD, Jaskanwal D. Sara, MBChB, Michel T. Corban, MD, Takumi Toya, MD, Ilke Özcan, MD, Lilach O. Lerman, MD PhD, Amir Lerman, MD Introduction: Coronary microvascular dysfunction (CMD) is prevalent in patients with heart failure with preserved ejection fraction. Subclinical ischemia and myocardial fibrosis in CMD might raise filling pressure, a hallmark of HFpEF, which induces secretion of NT-proB-type natriuretic peptide (NTpro-BNP). We sought to explore the relationship between CMD and NT-proBNP. Methods: We studied 698 patients with signs and/or symptoms of ischemia and with non-obstructive CAD (<40% angiographic stenosis) who underwent invasive CMD evaluation and had NT-proBNP checked within 6 weeks. CMD was defined as coronary flow reserve (CFR) (hyperemic flow/baseline flow as measured by the doppler wire) of ≤2.5 in response to intracoronary adenosine injection. Results: Overall mean age was 52.8±12.2 years, and women represented 69% of the patients. Log NT-proBNP showed a modest inverse correlation with CFR (Pearson’s R = -0.22, P<0.0001; Figure 1 ), which remained significant after adjusting for age and gender (Standardized ß coefficient = -0.14; P = 0.001). Patients with CMD had higher levels of NT-proBNP than those without (82 [44-190] vs. 62 (33-130], P <0.0001; Figure 2) . Conclusion: Declining coronary microvascular function is correlated with higher NT-proBNP levels. Patients with CMD had higher levels of NT-proBNP, a marker of elevated LV pressure, contributing to the possible role of CMD in early HFpEF pathophysiology. Keywords: Coronary microvascular dysfunction, NT-proBNP

PET-CT and detection of coronary artery disease

2021 ◽  
pp. 421-434
Author(s):  
Marcelo F. Di Carli
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Microvascular Dysfunction ◽  
Quantitative Information ◽  
Left Ventricular ◽  
Coronary Microvascular Dysfunction ◽  
Non Invasive ◽  
Atherosclerotic Burden ◽  
Pet Ct ◽  
Artery Disease

Myocardial perfusion PET/CT imaging has emerged as a powerful and comprehensive non-invasive approach for the management of patients with suspected or known coronary artery disease (CAD). The multiparametric PET/CT approach provides quantitative information about the extent and severity of focal and diffuse CAD, coronary microvascular dysfunction (CMD), atherosclerotic burden, and left ventricular function. Contemporary evidence demonstrates that this comprehensive approach is one of the most accurate non-invasive tools for diagnosis, risk prediction, and guiding management in patients with CAD. This chapter summarizes the versatility of the integrated PET/CT scan to provide detailed quantitative information tailored to the patient and clinical question. I then review patient-centred clinical applications using case vignettes to illustrate indications of PET/CT and how to present the findings into clinically actionable information for the practising cardiologist. In each case, I review the available data highlighting the diagnostic and prognostic value of the integrated PET/CT protocol.

Ischaemic heart disease in women

ESC CardioMed ◽  
2018 ◽  
pp. 2836-2840
Author(s):  
Martha Gulati
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Ischaemic Heart Disease ◽  
Obstructive Coronary Artery Disease ◽  
Diagnostic Testing ◽  
Atypical Presentation ◽  
Artery Disease

The more atypical presentation of women makes the diagnostic evaluation of symptomatic women challenging and results in more frequent referral for diagnostic testing to improve the precision of the ischaemic heart disease likelihood estimate. The classification of ischaemic heart disease and myocardial infarction has moved beyond the diagnosis of obstructive coronary artery disease and encompasses ischaemia that can occur in the presence and absence of obstructive coronary artery disease. Consideration of the different pathophysiology of ischaemia that may occur in women needs to be considered in the evaluation and treatment of ischaemic heart disease in women.

scholarly journals Coronary Angiographic Severity in Patients With Raised Plasma Homocysteine Level

1970 ◽  
Vol 1 (2) ◽  
pp. 169-173 ◽  
Author(s):  
MS Kabir ◽  
AAs Majumder ◽  
MS Bari ◽  
AW Chowdhury ◽  
AM Islam
Keyword(s):  
Coronary Artery Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Ischaemic Heart Disease ◽  
Homocysteine Level ◽  
Plasma Homocysteine ◽  
Plasma Homocysteine Level ◽  
Vessel Disease ◽  
Artery Disease ◽  
Single Vessel Disease

Background: Besides conventional classic risk factors of ischaemic heart disease other variables that have come under scrutiny for their potential contribution include estrogen deficiency, lipoprotein (a), plasma fibrinogen, plasminogen-activator inhibitor type I, endogenous tissue plasminogen activator (tPA), C-reactive protein and homocysteine. A number of studies have been undertaken worldwide shows strong correlation of raised fasting plasma homocysteine level with the development of atherosclerotic vascular diseases, myocardial infarction or increasing severity of coronary artery diseases. Objective: To find out the correlation of fasting plama homocysteine level with the severity of coronary artery disease in our population. Method: We undertook a study involving 100 patients of ischaemic heart disease (determined clinically & by non-invasive tests) in National Institute of Cardiovascular Diseases, Dhaka, Bangladesh, over the period of one year from January 2003 to December 2003. Out of 100 patients, 50 patients having normal homocysteine level were considered as control and another 50 patients having raised plasma homocysteine level were taken as cases. Result: Out of 50 patients, 20% had single vessel disease, 48% had double vessel disease and 32% had 3 vessel diseases. On the other hand in control group 10% patients had normal coronary artery disease, 40% had single vessel disease, 32% had double vessel disease and 18% had triple vessel disease. Conclusion: The study showed significant increase in number of coronary artery involvement by atherosclerotic lesions with increasing levels of plasma homocysteine level. Key words: Homocysteine; Coronary artery disease; Coronary angiogram. DOI: http://dx.doi.org/10.3329/cardio.v1i2.8124 Cardiovasc. j. 2009; 1(2) : 169-173

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