Abnormal coronary microvascular endothelial function in humans with asymptomatic left ventricular dysfunction

Abhiram Prasad, Stuart T. Higano, Jassim Al Suwaidi, David Holmes, Verghese Mathew, Geralyn Pumper, Ryan J. Lennon, Amir Lerman

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Background: Coronary endothelial dysfunction may potentially lead to myocardial ischemia and to the progression of heart failure. Though endothelial dysfunction is associated with advanced heart failure in humans, relatively little is known regarding their temporal relationship. Thus, the current study was designed to test the hypothesis that coronary endothelial dysfunction is present in patients with asymptomatic left ventricular dysfunction. Methods and Results: Three hundred patients without symptoms of heart failure, with normal or mildly diseased coronary arteries at angiography underwent coronary vascular reactivity evaluation using intracoronary adenosine, acetylcholine (ACH) and nitroglycerin. Patients were divided into 2 groups based on the left ventricular ejection fraction (EF): patients with asymptomatic left ventricular dysfunction (ALVD), EF <45% (n = 11); and patients with EF ≥45% (n = 289, controls). Except for a lower high-density lipoprotein level in patients with ALVD, there were no significant differences between the groups in regards to conventional cardiovascular risk factors. There was no difference in the change (mean ± SE) in epicardial diameter in response to ACH (-21.7% ± 7.2% vs -13.8% ± 1.5%, P = .3). The change in coronary blood flow in response to ACH was significantly attenuated in the patients with ALVD when compared to the controls (-18.5% ± 14.9% vs 74.0% ± 7.2%, P < .013). By multivariate analysis, EF was an independent predictor of coronary microvascular dilation with ACH (P < .001). Conclusion: The current study demonstrates that coronary microvascular endothelial dysfunction is present in ALVD. Thus, coronary endothelial dysfunction may be an early event in the pathophysiology of heart failure.

Original languageEnglish (US)
Pages (from-to)549-554
Number of pages6
JournalAmerican Heart Journal
Volume146
Issue number3
DOIs
StatePublished - Sep 1 2003

Fingerprint

Left Ventricular Dysfunction
Acetylcholine
Heart Failure
Stroke Volume
Nitroglycerin
HDL Lipoproteins
Coronary Angiography
Adenosine
Myocardial Ischemia
Blood Vessels
Coronary Artery Disease
Dilatation
Multivariate Analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Abnormal coronary microvascular endothelial function in humans with asymptomatic left ventricular dysfunction. / Prasad, Abhiram; Higano, Stuart T.; Al Suwaidi, Jassim; Holmes, David; Mathew, Verghese; Pumper, Geralyn; Lennon, Ryan J.; Lerman, Amir.

In: American Heart Journal, Vol. 146, No. 3, 01.09.2003, p. 549-554.

Research output: Contribution to journalArticle

Prasad, Abhiram ; Higano, Stuart T. ; Al Suwaidi, Jassim ; Holmes, David ; Mathew, Verghese ; Pumper, Geralyn ; Lennon, Ryan J. ; Lerman, Amir. / Abnormal coronary microvascular endothelial function in humans with asymptomatic left ventricular dysfunction. In: American Heart Journal. 2003 ; Vol. 146, No. 3. pp. 549-554.
@article{281e0b8a37d344588560007516fa14e4,
title = "Abnormal coronary microvascular endothelial function in humans with asymptomatic left ventricular dysfunction",
abstract = "Background: Coronary endothelial dysfunction may potentially lead to myocardial ischemia and to the progression of heart failure. Though endothelial dysfunction is associated with advanced heart failure in humans, relatively little is known regarding their temporal relationship. Thus, the current study was designed to test the hypothesis that coronary endothelial dysfunction is present in patients with asymptomatic left ventricular dysfunction. Methods and Results: Three hundred patients without symptoms of heart failure, with normal or mildly diseased coronary arteries at angiography underwent coronary vascular reactivity evaluation using intracoronary adenosine, acetylcholine (ACH) and nitroglycerin. Patients were divided into 2 groups based on the left ventricular ejection fraction (EF): patients with asymptomatic left ventricular dysfunction (ALVD), EF <45{\%} (n = 11); and patients with EF ≥45{\%} (n = 289, controls). Except for a lower high-density lipoprotein level in patients with ALVD, there were no significant differences between the groups in regards to conventional cardiovascular risk factors. There was no difference in the change (mean ± SE) in epicardial diameter in response to ACH (-21.7{\%} ± 7.2{\%} vs -13.8{\%} ± 1.5{\%}, P = .3). The change in coronary blood flow in response to ACH was significantly attenuated in the patients with ALVD when compared to the controls (-18.5{\%} ± 14.9{\%} vs 74.0{\%} ± 7.2{\%}, P < .013). By multivariate analysis, EF was an independent predictor of coronary microvascular dilation with ACH (P < .001). Conclusion: The current study demonstrates that coronary microvascular endothelial dysfunction is present in ALVD. Thus, coronary endothelial dysfunction may be an early event in the pathophysiology of heart failure.",
author = "Abhiram Prasad and Higano, {Stuart T.} and {Al Suwaidi}, Jassim and David Holmes and Verghese Mathew and Geralyn Pumper and Lennon, {Ryan J.} and Amir Lerman",
year = "2003",
month = "9",
day = "1",
doi = "10.1016/S0002-8703(03)00364-8",
language = "English (US)",
volume = "146",
pages = "549--554",
journal = "American Heart Journal",
issn = "0002-8703",
publisher = "Mosby Inc.",
number = "3",

}

TY - JOUR

T1 - Abnormal coronary microvascular endothelial function in humans with asymptomatic left ventricular dysfunction

AU - Prasad, Abhiram

AU - Higano, Stuart T.

AU - Al Suwaidi, Jassim

AU - Holmes, David

AU - Mathew, Verghese

AU - Pumper, Geralyn

AU - Lennon, Ryan J.

AU - Lerman, Amir

PY - 2003/9/1

Y1 - 2003/9/1

N2 - Background: Coronary endothelial dysfunction may potentially lead to myocardial ischemia and to the progression of heart failure. Though endothelial dysfunction is associated with advanced heart failure in humans, relatively little is known regarding their temporal relationship. Thus, the current study was designed to test the hypothesis that coronary endothelial dysfunction is present in patients with asymptomatic left ventricular dysfunction. Methods and Results: Three hundred patients without symptoms of heart failure, with normal or mildly diseased coronary arteries at angiography underwent coronary vascular reactivity evaluation using intracoronary adenosine, acetylcholine (ACH) and nitroglycerin. Patients were divided into 2 groups based on the left ventricular ejection fraction (EF): patients with asymptomatic left ventricular dysfunction (ALVD), EF <45% (n = 11); and patients with EF ≥45% (n = 289, controls). Except for a lower high-density lipoprotein level in patients with ALVD, there were no significant differences between the groups in regards to conventional cardiovascular risk factors. There was no difference in the change (mean ± SE) in epicardial diameter in response to ACH (-21.7% ± 7.2% vs -13.8% ± 1.5%, P = .3). The change in coronary blood flow in response to ACH was significantly attenuated in the patients with ALVD when compared to the controls (-18.5% ± 14.9% vs 74.0% ± 7.2%, P < .013). By multivariate analysis, EF was an independent predictor of coronary microvascular dilation with ACH (P < .001). Conclusion: The current study demonstrates that coronary microvascular endothelial dysfunction is present in ALVD. Thus, coronary endothelial dysfunction may be an early event in the pathophysiology of heart failure.

AB - Background: Coronary endothelial dysfunction may potentially lead to myocardial ischemia and to the progression of heart failure. Though endothelial dysfunction is associated with advanced heart failure in humans, relatively little is known regarding their temporal relationship. Thus, the current study was designed to test the hypothesis that coronary endothelial dysfunction is present in patients with asymptomatic left ventricular dysfunction. Methods and Results: Three hundred patients without symptoms of heart failure, with normal or mildly diseased coronary arteries at angiography underwent coronary vascular reactivity evaluation using intracoronary adenosine, acetylcholine (ACH) and nitroglycerin. Patients were divided into 2 groups based on the left ventricular ejection fraction (EF): patients with asymptomatic left ventricular dysfunction (ALVD), EF <45% (n = 11); and patients with EF ≥45% (n = 289, controls). Except for a lower high-density lipoprotein level in patients with ALVD, there were no significant differences between the groups in regards to conventional cardiovascular risk factors. There was no difference in the change (mean ± SE) in epicardial diameter in response to ACH (-21.7% ± 7.2% vs -13.8% ± 1.5%, P = .3). The change in coronary blood flow in response to ACH was significantly attenuated in the patients with ALVD when compared to the controls (-18.5% ± 14.9% vs 74.0% ± 7.2%, P < .013). By multivariate analysis, EF was an independent predictor of coronary microvascular dilation with ACH (P < .001). Conclusion: The current study demonstrates that coronary microvascular endothelial dysfunction is present in ALVD. Thus, coronary endothelial dysfunction may be an early event in the pathophysiology of heart failure.

UR - http://www.scopus.com/inward/record.url?scp=0041831262&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0041831262&partnerID=8YFLogxK

U2 - 10.1016/S0002-8703(03)00364-8

DO - 10.1016/S0002-8703(03)00364-8

M3 - Article

C2 - 12947377

AN - SCOPUS:0041831262

VL - 146

SP - 549

EP - 554

JO - American Heart Journal

JF - American Heart Journal

SN - 0002-8703

IS - 3

ER -