Age alters peripheral vascular endothelial function without affecting coronary flow reserve in healthy volunteers

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Bouly ◽  
M.P Bourguignon ◽  
S Ley ◽  
L Xuereb ◽  
P Bernhardt ◽  
...  
Keyword(s):  
Endothelial Dysfunction ◽  
Endothelial Function ◽  
Healthy Volunteers ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Funding Source ◽  
Vascular Endothelial ◽  
Flow Reserve ◽  
Vascular Beds ◽  
The Impact

Abstract Background Age is a key risk factor contributing to vascular endothelial dysfunction. Whether the impact of ageing is uniform on various vascular beds is unknown. Endothelial function is classically evaluated by the brachial flow mediated dilatation (FMD) after a brief occlusion which mainly involves nitric oxide (NO) production. However, FMD measurement, requiring highly trained technicians, has been shown to be associated with a high degree of variability. Endothelial function could be also assessed by cutaneous iontophoresis combined with Laser Doppler. By contrast to FMD, this method is easily done by nurses and shows less variability. In parallel, myocardial imaging allows measurement of coronary flow reserve (CFR) coupled with an adenosine challenge leading to both a NO release and a modulation of potassium channels. Purpose The aim of this study was to determine the impact of ageing on vasodilation of peripheral (cutaneous) and coronary blood vessels in healthy volunteers. Methods This prospective single German center study enrolled 75 healthy non-smoking normotensive volunteers, taking no medication. They were divided into three age-subgroups (n=25/group): 18–30, 50–59, and 60–70 years (women: 54, 27 and 23%, respectively). All subjects underwent clinical and laboratory evaluation. Peripheral endothelial function, expressed in cutaneous blood flow (delta CBF), was assessed through cutaneous microcirculation dilation by the non-invasive method using Laser Doppler Speckle Contrast Imaging (LSCI, Perimed) coupled with iontophoresis to locally deliver 125 nmoles of acetylcholine (Ach). The CFR was determined by cardiac magnetic resonance (CMR) coupling with an intravenous infusion of adenosine at 140 μg/kg/min for at least 3 minutes. Results Age was associated with a 23% reduction of peripheral endothelial function (delta CBF, p=0.005) in the elderly group (60–70y) vs. the younger one (18–30y) (median: 56.4 vs. 73.6). By contrast, calculated CFR was unchanged (median: 4.1 vs. 4.2, p=0.38). No relationship was observed between peripheral endothelial function (delta CBF) and CFR (r=0.01, p>0.97) in healthy volunteers. Conclusion In healthy volunteers, ageing is associated with a progressive peripheral but not with a coronary vascular dysfunction. This suggests that the impact of age on endothelial dysfunction depends on different vascular beds. Peripheral endothelial function assessment does not predict coronary vascular function in healthy volunteers. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Servier

scholarly journals Effects of coronary revascularization on global coronary flow reserve in stable coronary artery disease

2018 ◽  
Vol 115 (1) ◽  
pp. 119-129 ◽  
Author(s):  
Tadao Aikawa ◽  
Masanao Naya ◽  
Masahiko Obara ◽  
Osamu Manabe ◽  
Keiichi Magota ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Stable Coronary Artery Disease ◽  
Flow Reserve ◽  
Artery Disease ◽  
The Impact

Abstract Aims Coronary flow reserve (CFR) is an integrated measure of the entire coronary vasculature, and is a powerful prognostic marker in coronary artery disease (CAD). The extent to which coronary revascularization can improve CFR is unclear. This study aimed to evaluate the impact of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) on CFR in patients with stable CAD. Methods and results In a prospective, multicentre observational study, CFR was measured by 15O-water positron emission tomography as the ratio of stress to rest myocardial blood flow at baseline and 6 months after optimal medical therapy (OMT) alone, PCI, or CABG. Changes in the SYNTAX and Leaman scores were angiographically evaluated as indicators of completeness of revascularization. Follow-up was completed by 75 (25 OMT alone, 28 PCI, and 22 CABG) out of 82 patients. The median SYNTAX and Leaman scores, and baseline CFR were 14.5 [interquartile range (IQR): 8–24.5], 5.5 (IQR: 2.5–12.5), and 1.94 (IQR: 1.67–2.66), respectively. Baseline CFR was negatively correlated with the SYNTAX (ρ = −0.40, P < 0.001) and Leaman scores (ρ = −0.33, P = 0.004). Overall, only CABG was associated with a significant increase in CFR [1.67 (IQR: 1.14–1.96) vs. 1.98 (IQR: 1.60–2.39), P < 0.001]. Among patients with CFR <2.0 (n = 41), CFR significantly increased in the PCI [1.70 (IQR: 1.42–1.79) vs. 2.21 (IQR: 1.78–2.49), P = 0.002, P < 0.001 for interaction between time and CFR] and CABG groups [1.28 (IQR: 1.13–1.80) vs. 1.86 (IQR: 1.57–2.22), P < 0.001]. The reduction in SYNTAX or Leaman scores after PCI or CABG was independently associated with the percent increase in CFR after adjusting for baseline characteristics (P = 0.012 and P = 0.011, respectively). Conclusion Coronary revascularization ameliorated reduced CFR in patients with obstructive CAD. The degree of improvement in angiographic CAD burden by revascularization was correlated with magnitude of improvement in CFR.

Systemic nitric oxide synthase inhibition improves coronary flow reserve to adenosine in patients with significant stenoses

2007 ◽  
Vol 293 (4) ◽  
pp. H2178-H2182 ◽  
Author(s):  
Philipp A. Kaufmann ◽  
Ornella E. Rimoldi ◽  
Tomaso Gnecchi-Ruscone ◽  
Thomas F. Luscher ◽  
Paolo G. Camici
Keyword(s):  
Nitric Oxide ◽  
Nitric Oxide Synthase ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Luminal Diameter ◽  
Normal Volunteers ◽  
Flow Reserve ◽  
Positron Emission ◽  
Oxide Synthase ◽  
The Impact

We studied the impact of systemic infusion of the nitric oxide synthase (NOS) inhibitor NG-monomethyl-l-arginine (l-NMMA) on coronary flow reserve (CFR) in patients with coronary artery disease (CAD). We have previously demonstrated that CFR to adenosine was significantly increased after systemic infusion of l-NMMA in normal volunteers but not in recently transplanted denervated hearts. At baseline, myocardial blood flow (MBF; ml·min−1·g−1) was measured at rest and during intravenous administration of adenosine (140 μg·kg−1·min−1) in 10 controls (47 ± 5 yr) and 10 CAD patients (58 ± 8 yr; P < 0.01 vs. controls) using positron emission tomography and 15O-labeled water. Both MBF measurements were repeated during intravenous infusion of 10 mg/kg l-NMMA. CFR was calculated as the ratio of MBF during adenosine to MBF at rest. CFR was significantly higher in healthy volunteers than in CAD patients and increased significantly after l-NMMA in controls (4.00 ± 1.10 to 6.15 ± 1.35; P < 0.0001) and in patients, both in territories subtended by stenotic coronary arteries (>70% luminal diameter; 2.06 ± 1.13 to 3.21 ± 1.07; P < 0.01) and in remote segments (3.20 ± 1.23 to 3.92 ± 1.62; P < 0.05). In conclusion, CFR can be significantly increased in CAD by a systemic infusion of l-NMMA. Similarly to our previous findings in normal volunteers, this suggests that adenosine-induced hyperemia in CAD patients is constrained by a mechanism that can be relieved by systemic NOS inhibition with l-NMMA.

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