Effects of Anti-Inflammatory Treatment and Surgical Intervention on Endothelial Glycocalyx, Peripheral and Coronary Microcirculatory Function and Myocardial Deformation in Inflammatory Bowel Disease Patients: A Two-Arms Two-Stage Clinical Trial

Sixty inflammatory bowel disease (IBD) patients (45 Crohn disease and 15 ulcerative colitis, 40 ± 13 years, 53% male) were examined at baseline and 4 months after intervention (surgical (35 patients) or anti-TNFa treatment (25 patients)). IBD severity, using Mayo score, Harvey–Bradshaw Index (HBI) and biomarkers, was correlated with cardiovascular markers. At baseline, the disease severity, the white blood cells (WBC) values and the reducing power (RP) were significantly correlated with the aortic pulse wave velocity (PWV) (r = 0.4, r = 0.44 and r = 0.48, p < 0.05) and the lateral mitral E’ velocity (r = 0.35, p < 0.05 and r = 0.3, p < 0.05). Four months after intervention, there was a reduction of WBC (1962.8/mm3 ± 0.425/mm3, p < 0.001), C-reactive protein (CRP) (8.1 mg/L ± 1.7 mg/L, p < 0.001), malondialdehyde (MDA) (0.81 nmol/mg ± 0.37, p < 0.05) and glycocalyx perfused boundary region (PBR 5-25) (0.24 μm ± 0.05 μm, p < 0.01). Moreover, the brachial flow mediated dilatation (FMD), the coronary flow reserve (CFR) and the left ventricle global longitudinal strain (LV GLS) were significantly improved for both groups (4.5% ± 0.9%, 0.55 ± 0.08, 1.4% ± 0.35%, p < 0.01), while a more significant improvement of PWV/GLS was noticed in the anti-TNFa group. IBD severity is associated with vascular endothelial, cardiac diastolic, and coronary microcirculatory dysfunction. The systemic inflammatory inhibition and the local surgical intervention lead to significant improvement in endothelial function, coronary microcirculation and myocardial deformation.

Download Full-text

P831 Anti-inflammatory treatment improves endothelial glycocalyx, peripheral and coronary microcirculatory function and myocardial deformation in inflammatory bowel disease patients

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.481 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

C Triantafyllou ◽

I Ikonomidis ◽

M Nikolaou ◽

G Bamias ◽

J Thymis ◽

...

Keyword(s):

Diastolic Dysfunction ◽

Surgical Intervention ◽

White Blood Cells ◽

Myocardial Deformation ◽

Doppler Imaging ◽

Endothelial Glycocalyx ◽

Flow Reserve ◽

Inflammatory Bowel ◽

Anti Inflammatory ◽

Microcirculatory Function

Abstract Funding Acknowledgements Hellenic Society of IBD study (EOMIFNE) Introduction Inflammatory bowel diseases (IBD) alter gastrointestinal physiology and mucosal immunity through a complex inflammatory process. The extensive inflammation leads to significant arterial endothelial dysfunction as well as modification of cardiac structure and function. This study is performed to test the hypothesis that treatment with TNF-a inhibitor or surgical intervention in the IBD population improves cardiovascular function through anti-inflammatory mechanisms. Methods Thirty-seven IBD patients (28 CD and 9 UC, 39 ± 12 years, 62% male) were examined at baseline and 4 months after pharmaceutical (TNF-a inhibitor) (16 patients) or surgical intervention (21 patients). Subjects with a history of established cardiovascular risk factors were excluded. We measured a) carotid-femoral pulse wave velocity (PWV - Complior SP ALAM), central systolic blood pressure (cSBP) and augmentation index (AI), b) flow mediated dilatation (FMD) of the brachial artery), c) perfused boundary region(PBR) of the sublingual arterial microvessels using Sideview Darkfield imaging, d) LV longitudinal strain (GLS), strain rate (GLSR) and (PWV/GLS) as a marker of ventricular-arterial coupling, e) peak LV twisting, peak twisting velocity (pTwVel) and peak untwisting velocity (pUtwVel) using speckle tracking echocardiography, f) mitral annulus velocities by tissue doppler imaging (S’ and E’) and mitral inflow velocity (E), g) coronary flow reserve (CFR) by Doppler echocardiography, h) C-reactive protein (CRP), white blood cells (WBC). IBD severity was quantified using Mayo score and Harvey-Bradshaw Index (HBI) for UC and CD respectively, and correlated with the cardiovascular disease markers. Results At baseline, the disease severity score was significantly correlated with markers of diastolic dysfunction (lateral mitral E’ velocity r=-0.352, p < 0.05, UntwVelE r = 0.389, p < 0.05), while the WBC values were negatively associated with lateral mitral E’ velocity: r=-0.5, p < 0.05 and CFRvti (r=-0.332, p = 0.05). Four months after anti-inflammatory treatment, there was a reduction of CRP (15.5 ± 4.7 mg/L vs 5.1 ± 2.1 mg/L, p < 0.05) and WBC values (8.6 ± 0.6 vs 6.6 ± 0.7 x 103, p = 0.06). Moreover, post-treatment, there was a significant reduction of central arterial AI (3.58 ± 4.13 vs 0 ± 4.96, p < 0.05), PBR10-19 (2.47 ± 0.09 vs 2.24 ± 0.08 μm, p < 0.05) and PBR5-25 (2.31 ± 0.08 vs 2.14 ± 0.06 μm, p = 0.05) and increase of FMD (7.6%±0.7 vs 12.2%±1.7, p < 0.05), CFR (2.6 ± 0.1 vs 3.2 ± 0.14, p < 0.05), GLS (-18.7 ± 0.46 vs -20 ± 0.49, p < 0.05) and PWV/GLS (-0,48 ± 0.027 vs -0,42 ± 0.028, p < 0.05). No difference in the examined markers was observed between patients treated with anti-TNFa or surgery (p = NS). Conclusion IBD severity is associated with vascular and diastolic dysfunction. Anti-TNFa inhibition treatment or surgical intervention in IBD lead to improved myocardial deformation, endothelial and coronary microcirculatory function possibly through the reduction of excess inflammatory burden.

Download Full-text

Effects of anti-inflammatory treatment and surgical intervention on endothelial glycocalyx, peripheral and coronary microcirculation and myocardial deformation in inflammatory bowel disease patients

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.423 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

C Triantafyllou ◽

I Ikonomidis ◽

M Nikolaou ◽

G Bamias ◽

J Thymis ◽

...

Keyword(s):

Surgical Intervention ◽

Augmentation Index ◽

White Blood Cells ◽

Mitral Annulus ◽

Myocardial Deformation ◽

Doppler Imaging ◽

Endothelial Glycocalyx ◽

Flow Reserve ◽

Anti Inflammatory ◽

The Difference

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): EOMIFNE (Hellenic Society of IBD study) Introduction IBD alter gastrointestinal physiology and mucosal immunity through a complex inflammatory process which leads to significant arterial endothelial dysfunction and modification of cardiac structure and function. This study is performed to test the hypothesis that treatment with TNF-a inhibitor or surgical intervention improves cardiovascular function through anti-inflammatory mechanisms. Methods 57 IBD patients (45 CD and 12 UC, 40 ± 8 years, 57% male) were examined at baseline and 4 months after pharmaceutical (antiTNF-a) or surgical intervention. Subjects with a history of established cardiovascular risk factors were excluded. We measured a) carotid-femoral pulse wave velocity (PWV - Complior SP ALAM) and augmentation index (AI), b) flow mediated dilatation (FMD) of the brachial artery), c) perfused boundary region (PBR) of the sublingual arterial microvessels, d) LV longitudinal strain (GLS) and (PWV/GLS) as a marker of ventricular-arterial coupling, e) peak LV twisting, peak twisting velocity (pTwVel) and peak untwisting velocity (pUtwVel) using speckle tracking echocardiography, f) mitral annulus velocities by tissue doppler imaging (S’ and E’) and mitral inflow velocity (E), g) coronary flow reserve (CFR) by Doppler echocardiography, h) C-reactive protein (CRP), white blood cells (WBC). IBD severity was quantified using Mayo score and Harvey-Bradshaw Index (HBI) for UC and CD respectively. Results At baseline, the disease severity score and the WBC values were significantly correlated with peripheral PWV (r = 0.3, p < 0.05 and r = 0.364, p < 0.05), while central arterial AI was associated with median arterial pressure (r = 0.479, p < 0.05), lateral and septal mitral E’ velocity (r=-0.651, p < 0.05 and r=-0.587, p < 0.05). Four months after treatment, there was a reduction of CRP (13 ± 2.8 mg/L vs 3.9 ± 1.2 mg/L, p < 0.05), CFR (2.5 ± 0.08 vs 3.1 ± 0.11, p < 0.05) and PBR5-25 (2.27 ± 0.06 vs 2.09 ± 0.05 μm, p < 0.05) more significantly in pharmaceutical group (p < 0.05 vs p = 0.23). Moreover, there was an improvement of GLS (-18.6 ± 0.37 vs -20 ± 0.34, p < 0.05), LS-4ch (-18.3 ± 0.47 vs -19.3 ± 0.41, p < 0.05), GcircS (-18.1 ± 0.7 vs -20.1 ± 0.9, p < 0.05) and FMD (7.2%±0.6 vs 11.8%±1.4, p < 0.05). Moreover, there was an overall improvement of PWV/GLS (-0.49 ± 0.02 vs -0.43 ± 0.02, p < 0.05). It was greater after with anti-TNFa therapy compared to surgery (p < 0.05 vs p = 0.1) and particular for the GLS component (p < 0.05 vs p = 0.07). The difference in PBR5-25 was significantly correlated with the difference in GLS (r=-0.403, p < 0.05) and PWV/GLS (r = 0.421, p < 0.05). Conclusion IBD severity is associated with vascular and diastolic dysfunction, with significant improvement after anti-inflammatory treatment. Systemic anti-TNFa inhibition leads to significant improvement in myocardial deformation, endothelial and coronary microcirculatory function compared with local intestinal surgical intervention, possibly through a systemic reduction of excess inflammatory burden.

Download Full-text

The Changing Prognosis of Ulcerative Colitis and Crohn’s Disease by Decades

Crohn's & Colitis 360 ◽

10.1093/crocol/otab008 ◽

2021 ◽

Author(s):

Burton I Korelitz ◽

Judy Schneider

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Medical Therapy ◽

Bowel Disease ◽

Surgical Intervention ◽

Inflammatory Bowel

Abstract We present a bird’s eye view of the prognosis for both ulcerative colitis and Crohn’s disease as contained in the database of an Inflammatory Bowel Disease gastroenterologist covering the period from 1950 until the present utilizing the variables of medical therapy, surgical intervention, complications and deaths by decades.

Download Full-text

Predictors of Surgical Intervention in Patients with Inflammatory Bowel Disease

QJM ◽

10.1093/qjmed/hcab100.017 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Khaled Hamdy Abd El Megeed ◽

Shereen Abou Bakr Saleh ◽

Christina Alphonse Anwar ◽

Ahmed Elkattary Mohamed Elkattary

Keyword(s):

Inflammatory Bowel Disease ◽

Surgical Treatment ◽

Bowel Disease ◽

Surgical Intervention ◽

High Sensitivity ◽

Medical Patients ◽

Mayo Score ◽

Calprotectin Level ◽

Inflammatory Bowel ◽

The Mean

Abstract Background Inflammatory bowel disease (IBD) is comprised of two major disorders: Ulcerative Colitis and Crohn’s disease. Ulcerative Colitis affects the colon, where as Crohn’s disease can involve any component of the gastrointestinal tract from the mouth to the perianal area. These disorders have somewhat different pathologic and clinical characteristics, but with substantial overlap; their pathogenesis remains poorly understood. Objective To determine & detect different predictors that help us to characterize patients with high probability of undergoing surgical intervention for inflammatory bowel diseases. Patients and Methods The present study was designed to detect & identify possible factors that can be used to predict surgical intervention in patients with IBD. The present study was a case control study that was conducted on 80 patients with inflammatory bowel disease (either controlled by medical treatment or needed surgical intervention as a part of disease control) who were recruited form Ain-Shams university hospitals and El Quabbary general hospital in Alexandria. In the present study, the mean age of the included patients was 36.67 ±8.5 years old and 50% of the patients were males. The mean age at the onset of the disease was 25.81 ±6.8 years old. Results In the present study, there were statistically significant differences between surgical and medical patients in terms of CDAI for CD (p < 0.001) and Mayo score for UC (p < 0.001). Surgical patients were more likely to have higher scores. CDAI and Mayo score were negative predictors of surgical treatment. CDAI score > 287 and Mayo score > 8.5 achieved high sensitivity and specificity for the detection of surgical treatment. In the present study, we found that there was statistically significant differences between surgical and medical patients in terms of Stool Calprotectin level. Surgical patients were more likely to have higher Stool Calprotectin level. Stool Calprotectin level was negative predictor of surgical treatment at a level of > 341.5 microgm/gm with high sensitivity and specificity. Conclusion Surgical treatment is a common outcome in IBD. Certain clinical features and the extent of disease are risk factors for surgical intervention. Our study indicates that smoking, Chron’s disease, perianal disease, granulomas, higher severity scores, higher stool Calprotectin level, CRP, and ESR were associated with higher risks of surgical intervention. In addition, smoking, peri-anal disease, CDAI, Mayo score, Stool Calprotectin level, and CRP level were predictors of surgical treatment. The findings of our analysis have implications for practice, particularly in the promotion of preoperative individualized risk prediction. The ability to predict which patients will need surgery and target more intensive, early treatment to that group would be invaluable. Further research through large prospective cohort studies is needed to confirm our findings and conclusions.

Download Full-text