Endothelial nitric oxide synthase gene polymorphisms in patients with slow coronary flow.

BACKGROUND AND AIMS: The aim of this study was to explore potential associations of the intron 4 variable number of tandem repeats (VNTR) and E298A polymorphisms of the endothelial nitric oxide synthase (eNOS) gene with slow coronary flow (SCF). The association between plasma nitrate and nitrite (NO x ) concentrations and eNOS gene polymorphisms was also assessed. MATERIALS AND METHODS: The intron 4 VNTR and E298A polymorphisms of the eNOS gene were evaluated in the isolated DNA blood samples obtained from the SCF patient group (n = 30) and healthy group consisted of age- and sex-matched controls (n = 61). RESULTS: Plasma NO x level was significantly lower in patients with SCF than in controls. In addition, patients with SCF have significantly lower nitric oxide levels than control subjects within each genotype variants. The allele and genotyped frequencies of the eNOS intron 4 VNTR and E298A polymorphisms were similar between patients with SCF and the controls. Plasma NO x concentrations with respect to the relevant genotypes were found insignificant. DISCUSSION AND CONCLUSION: Plasma NO x is lower in patients with SCF than in healthy subjects. Our findings may suggest the lack of association between intron 4 VNTR and E298A polymorphisms of the eNOS gene and SCF.

Teleconsultation of coronary angiograms using smartphones and an audio/video conferencing application.

OBJECTIVE: To examine the feasibility and accuracy of teleconsultation of coronary angiograms using iPhone 4 and FaceTime. METHODS: The study was conducted in two stages. Coronary angiograms of 100 patients with single-vessel disease were retrospectively selected by a core laboratory unit and then re-evaluated by a consultant cardiologist on both an iPhone 4 screen via the FaceTime application and on the workstation monitor of the angiography laboratory. The interpretations of the consultant cardiologist on localization and severity of angiographic lesions were recorded and compared with those of the core laboratory. Using the same teleconsultation system, the consultant cardiologist outside the hospital was presented live angiographic images of 10 patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction. RESULTS: Interpretations of the consultant cardiologist on the localization and severity of 100 lesions on both the smartphone screen and workstation monitor showed high levels of agreement with the results of the core laboratory (for all, κ > 0.80). Of 10 patients whose PCI was performed under live video teleconsultation, eight patients underwent successful PCI while two patients had normal coronary arteries. There was an excellent agreement between the consultant cardiologist and the operator regarding lesion localization. CONCLUSIONS: Smartphones allow highly accurate interpretations on angiographic lesions and thus may serve as a supplementary teleconsultation tool in both elective and emergency situations.

Evaluation of blood rheology in patients with coronary slow flow or non-obstructive coronary artery disease.

Coronary slow flow (CSF) has been documented in 25% of patients evaluated for angina or angina-like chest pain, despite the presence of normal epicardial coronary arteries on angiography. The risk for the development of clinical events in patients with non-obstructive coronary artery disease (NOCAD) is higher than in patients with completely normal coronary arteries. The object of this study was to evaluate changes in blood and plasma viscosity in patients with CSF or NOCAD. The study included 147 subjects (CSF, n = 42, NOCAD, n = 42 and controls, n = 63). Blood and plasma viscosity, complete blood counts, fibrinogen, and high sensitivity C-reactive protein (hs CRP) levels were measured. There was no significant difference between the groups with respect to blood and plasma viscosity (p > 0.05). Hemoglobin, hematocrit, and erythrocyte counts were significantly higher in the CSF group compared to the NOCAD group (p = 0.017, p = 0.023 and p = 0.023 respectively) and the control group (p = 0.026, p = 0.02 and p = 0.02, respectively). High sensitivity CRP levels in the NOCAD group were higher than the CSF group and the control group (p = 0.001 and p = 0.018, respectively). In conclusion, no significant difference was observed in the blood and plasma viscosity in patients with CSF or NOCAD. Increases in hemoglobin and hematocrit values without an increase in viscosity may play a role in the pathophysiology of CSF.

Short-term effects of fluvastatin therapy on plasma interleukin-10 levels in patients with chronic heart failure.

BACKGROUND: Experimental data demonstrated that inflammatory mediators, such as pro-inflammatory and anti-inflammatory cytokines and their receptors might have important role in the development and the progression of heart failure (HF). Statins were shown to downregulate inflammatory cytokines in HF. Interleukin (IL)-10 is one of the most important anti-inflammatory cytokines. The effect of statin therapy on plasma IL-10 levels is not known in patients with HF. We conducted this study to investigate the effects of fluvastatin therapy on plasma IL-10 cytokine concentration in patients with HF. METHODS: A total of 29 patients with ischemic HF were included in this prospective uncontrolled study. Patients were assigned to fluvastatin (80 mg/day) after baseline examinations. Determination of biochemical parameters including lipids, IL-10, and tumor necrosis factor-alpha were performed at baseline and 12 weeks after the initiation of fluvastatin therapy. All participants also underwent symptom-limited exercise tolerance test at baseline and 12 weeks, and heart rate recovery (HRR) was calculated. RESULTS: A significant elevation in the plasma levels of IL-10 after 12 weeks of fluvastatin treatment (4.8+ or -1.0 vs. 6.5+ or -1.3 pg/ml, P=0.002) was observed. Plasma tumor necrosis factor-alpha levels were significantly decreased after fluvastatin therapy (6.3+ or -2.3 vs. 4.8+ or -1.4 pg/ml, P=0.003). Fluvastatin therapy significantly improved HRR at 1 min after 12 weeks compared with baseline (19+ or -7 vs. 24+ or -9 bpm, P<0.001). A positive correlation between the change in the levels of IL-10 and the change in HRR at 1 min (r=0.57, P<0.001) was observed. CONCLUSION: Fluvastatin therapy might lead to an increase in plasma IL-10 levels and an associated improvement in vagal tonus as assessed by HRR at 1 min in patients with HF. These findings might partly explain the possible benefit observed in statin trials.

Short- and long-term effect of simvastatin therapy on the heterogeneity of cardiac repolarization in diabetic patients.

The interlead variability of QT interval in the 12-lead electrocardiogram, QT dispersion (QTd), has been shown to reflect dispersion of ventricular refractoriness and may provide a measure of arrhythmogenic potential in diabetic patients. QTd and heart rate corrected QTd (QTcd) were also proposed to be accurate predictors of cardiac death in patients with diabetes. In recent years, experimental and clinical evidence demonstrates that statins exert antiarrhythmic properties. Therefore, in the present study, we have examined whether simvastatin treatment has any effect on the QTd and QTcd in patients with diabetes mellitus. Sixty type 2 diabetic patients without known coronary artery disease and low-density lipoprotein cholesterol >100mg/dl and 30 age and sex-matched non-diabetic controls were included in a prospective study. Out of 60 diabetic patients, 30 were treated with simvastatin 40 mg/day for 1 year and the remaining 30 subjects were served as diabetic controls. No lipid lowering therapy was administered to the diabetic and the non-diabetic controls. QTd and QTcd of treated diabetics and the non-diabetic controls were measured at baseline, 6, 12 weeks and at 1 year. QTd and QTcd of the diabetic controls were obtained at baseline, 6 and 12 weeks. Both QTd and QTcd were significantly greater in patients with the diabetes than in the non-diabetic controls at baseline (52+/-13 ms vs. 41+/-12 ms, p<0.001 and 62+/-17 ms vs. 42+/-11 ms, p<0.001, respectively). Simvastatin therapy significantly decreased both QTd and QTcd at the end of first year compared to baseline (51+/-15 ms vs. 33+/-11 ms, p<0.001 and 60+/-18 ms vs. 38+/-12 ms, p<0.001, respectively). No significant change were found in QTd and QTcd in the non-diabetic (p=0.29 and p=0.87 by ANOVA, respectively) and in the diabetic controls (p=0.72 and p=0.57, by ANOVA, respectively). This study suggests for the first time that simvastatin treatment in diabetic patients with hyperlipidemia is associated with an improvement in the heterogeneity of cardiac repolarization. This may be one of the mechanisms for the reduction in clinical events reported in the survival studies with statins. Further prospective randomized studies are warranted to confirm our findings.

Rheumatic mitral valve stenosis is associated with impaired flow-mediated dilatation.

It has been demonstrated that rheumatic mitral valve stenosis (RMVS) is associated with an increase in markers of endothelial dysfunction. It is not known whether this association indicates an impairment of flow-mediated dilatation (FMD) of the vascular endothelium. Thirty patients with RMVS and 30 healthy subjects were studied. FMD in patients with RMVS was significantly smaller than in healthy controls (11.9+/-0.4% vs 15.4+/-0.70%, p=0.003). The absolute change in brachial artery diameter in patients with RMVS was also significantly smaller than in healthy subjects (0.42+/-0.26 mm vs 0.64+/-0.32 mm, p<0.001). These findings suggest that vascular endothelial function is altered in patients with RMVS.

Comparison of different regression analyses for identifying risk factors in obese and nonobese patients with coronary artery disease.

This study was designed to assess conventional and novel risk factors in obese and nonobese patients with coronary artery disease (CAD) by using multivariate forward and univariate logistic regression analysis and to find the best model of analysis for identifying these risk factors. The study group consisted of 398 patients who consecutively underwent coronary angiography for the investigation of chest pain, except overweight patients. In univariate logistic regression analysis, high C-reactive protein and cigarette smoking were found to be the strongest variables in obese and nonobese patients with CAD, respectively. In multivariate forward logistic regression analysis, some risk factors were not found as predictors of CAD. Multivariate forward logistic regression analysis with the advantage of a high predictable ratio may be more useful for the analysis of risk factors in patients with CAD.

Value of preoperative echocardiography in the prediction of postoperative atrial fibrillation following isolated coronary artery bypass grafting.

The value of echocardiography, especially tissue Doppler imaging (TDI), in the assessment of risk of postoperative atrial fibrillation (AF) after coronary artery bypass grafting (CABG) is not clear. One hundred two consecutive patients (80 men; mean age 61 +/- 10 years) who underwent elective isolated CABG were included in the study. All patients underwent conventional transthoracic echocardiography and TDI of the left and right heart before surgery. Also, 24-hour Holter recordings were obtained for all patients. The study end point was the development of postoperative AF. The surgical mortality rate was 2%. Postoperative AF occurred in 18 patients (18%). Patients with postoperative AF have been significantly older than patients without postoperative AF (73 +/- 7 vs 58 +/- 9 years, respectively; p <0.001). Compared with patients without postoperative AF, a significantly higher proportion of patients with postoperative AF experienced paroxysmal AF before surgery (6% vs 33%, respectively; p = 0.001). Patients with postoperative AF had a significantly larger mean left atrial diameter compared with patients without postoperative AF (37 +/- 3 vs 35 +/- 3 mm, respectively; p = 0.012). Multivariate logistic regression analysis identified age as the most significant predictor of postoperative AF (odds ratio 1.254, 95% confidence interval 1.127 to 1.396; p <0.001). Of the echocardiographic variables, only left atrial diameter was identified as a significant predictor of postoperative AF (odds ratio 1.250, 95% confidence interval 1.055 to 1.562; p = 0.047). In conclusion, in the prediction of postoperative AF after isolated CABG, preoperative transthoracic echocardiography, including both conventional echocardiography and TDI, is of little value.

Assessing coronary blood flow with TIMI frame count method in isolated myocardial bridging.

Myocardial bridging (MB) is a congenital anomaly of coronary arteries and its functional significance remains controversial. Using the TIMI frame count (TFC) method, the authors investigated whether the coronary blood flow velocity is decreased in MB. The study included 18 patients (group 1; 12 men and 6 women; mean age 50 +/-6 years) who had angiographically proven MB and otherwise normal coronary arteries and 20 subjects (group 2; 13 men and 7 women; mean age 50 +/-7 years) with normal-appearing coronary arteriograms. TFC of each group was determined and correlation between TFC and various factors including percent systolic narrowing, age, gender, body mass index, blood pressure, and echocardiographic parameters (ejection fraction, left-right ventricle wall thickness, and diameters) was investigated. Baseline characteristics were similar in the groups. All of the MB was localized to the left anterior descending (LAD) artery. Corrected TFC(LAD) frame count (CTFC) was significantly higher in group 1 than in group 2 (24.7 +/-2.1 vs 22.1 +/-1.9 frames/s, p = 0.001). Circumflex and right coronary artery frames counts were similar in the groups (22.4 +/-2.4 vs 21.3 +/-2.3 frames/s, p = 0.18, 23.1 +/-2.2 vs 23.4 +/-2.1 frames/s, p = 0.7) On correlation analysis, there was no correlation between TFC and the factors investigated. CTFC of patients with MB was higher than of those with normal coronary arteries, irrespective of the degree of systolic narrowing. This may suggest that coronary blood flow is decreased in patients with MB compared to patients having normal coronary arteries.

Effect of slow coronary flow on electrocardiographic parameters reflecting ventricular heterogeneity.

QT interval dispersion reflects regional variations in ventricular repolarization and cardiac electrical instability. Previous studies have showed that QT interval dispersion changes during episodes of myocardial ischemia. Slow coronary flow (SCF) in epicardial coronary arteries is a rare and unique angiographic finding. Whether this pattern of flow is associated with electrocardiographic abnormalities is unknown. Therefore, this study was designed to investigate whether SCF results in electrocardiographic (ECG) changes compared to normal coronary flow. For this aim 24 patients with angiographically proven SCF who had no obstructive coronary lesion (group I) and 25 patients without coronary artery disease (group II) were included in the study. Both groups underwent a routine standard 12-lead surface electrocardiogram recorded at 50 mm/s during rest. QT dispersion (QTd), corrected QT (QTc), and corrected QT dispersion (QTcd) were calculated. Distributions of sex, age, body mass index (BMI), and cardiac risk factors were similar in the 2 groups. Mean heart rate was similar in the 2 groups (74 +/-8 vs 77 +/- 7 p > 0.05). Mean QRS interval durations were similar in the groups (92 +/-7 vs 90 +/-6 ms p > 0.005). In group I, QTd, QTcd, and QTc, were significantly higher than in group II (QTd: 73 +/-14 vs 40 +/-14; QTcd: 71 +/-15 vs 42 +/-9; QTc: 414 +/-14 vs 388 +/-13, respectively p <0.05). In conclusion, SCF was found to be associated with prolonged QT interval and increased QT dispersion. Ischemia in microvascular level and/or altered autonomic regulation of the heart may be responsible mechanisms.

Increased high sensitive CRP level and its significance in pathogenesis of slow coronary flow.

Previous studies have suggested that microvascular abnormalities cause slow coronary flow (SCF). The role of inflammation has not been investigated, to date. The purpose of this study was to determine the role of inflammation in pathogenesis of SCF. The study included 32 patients with angiographically proven SCF (mean age 49 +/-9 years) (group I) and 30 subjects with normal coronary flow (mean age 48 +/-8 years) (group II). Blood samples were collected for high sensitive CRP (hs-CRP) measurements. Thrombolysis in myocardial infarction frame count (TFC) was compared in both groups. Distribution of sex, age, body mass index (BMI), arterial blood pressure, and ejection fraction were similar in the 2 groups. TFC was significantly higher in group I than in group II for each artery including left anterior descending coronary artery (LAD), left circumflex artery (Cx), and right coronary artery (RCA) (38.9 +/-6.6 vs 22.1 +/-1.8 frames, p = 0.0001; 39.6 +/-4.9 vs 22.3 +/-1.8 frames, p = 0.001 ; 39.0 +/-3.8 vs 22.0 +/-1.8 frames, p = 0.001, respectively). In group I, serum hs-CRP concentration was significantly higher than that of group II (0.6 +/-0.58 vs 0.24 +/-0.1 mg/dL p = 0.03). Correlation analysis showed a positive correlation between hs-CRP level and TFC for each artery (for CTFC(LAD), r = 0.36 p = 0.004; for TFC(Cx), r = 0.42 p = 0.003; and for TFC(RCA), r = 0.42, p = 0.0001 respectively). Increased hs-CRP level suggests that inflammation may be associated with pathogenesis of SCF or at least in part contributes to its pathogenesis. Increased hs-CRP level may also be an early marker of impaired coronary blood flow.

Coronary flow reserve is impaired in patients with slow coronary flow.

BACKGROUND: Slow coronary flow (SCF) in a normal coronary angiogram is a well-recognized clinical entity, but its etiopathogenesis remains unclear. However, previous studies have suggested that microvascular abnormalities and endothelial dysfunction responsible for SCF. Accordingly, we hypothesized that SCF phenomenon may be a form, at least early phase, of atherosclerosis that involve both small vessels and epicardial coronary arteries, and therefore we investigated coronary flow reserve (CFR) reflecting coronary microvascular function in patients with SCF. METHODS: Twenty subjects with SCF and 15 control subjects with normal coronary flow were studied. Coronary flow was quantified according to TIMI frame count (TFC). Coronary diastolic peak flow velocities were measured at baseline and after dipyridamole infusion. CFR was calculated as the ratio of hyperemic to baseline diastolic peak velocities. RESULTS: Demographic features, coronary risk factors, echocardiographic measurements except diastolic function parameters, and biochemical measurements were similar between the groups. CFR values were significantly lower in subjects with SCF than in the control group (1.99+/-0.38 versus 2.99+/-0.47, P<0.0001). In addition, TIMI frame count independently correlated with CFR. CONCLUSION: These findings suggest that CFR, which reflects coronary microvascular function, is impaired in patients with SCF, and corrected TFC well correlates with CFR.

Value of prolonged QRS duration as a predictor of low cardiac output syndrome in patients with impaired left ventricular systolic function who undergo isolated coronary artery bypass grafting.

This study determined whether prolonged QRS duration (QRSd; > or =120 ms) is an independent predictor of low cardiac output syndrome (LCOS) in patients with low left ventricular (LV) ejection fraction (EF) who underwent isolated coronary artery bypass grafting (CABG). Abnormal LV systolic function places patients at greater risk for developing LCOS after isolated CABG. In patients with this form of ventricular function impairment, prolonged QRSd is associated with adverse hemodynamic effects. Clinical, operative, and outcome data from 190 consecutive patients with LVEF <50% who underwent isolated CABG (mean 62 +/- 9 years of age) were retrospectively analyzed. For all patients, preoperative QRSd was determined. LCOS was the primary outcome investigated. Fifty-seven patients (30%) developed LCOS. Compared with the subgroup without LCOS, the subgroup with this syndrome had significantly larger proportions of patients with LVEF <30% and prolonged QRSd. In addition, the group that developed LCOS had a longer mean QRSd (117 +/- 25 vs 102 +/- 17 ms, respectively, p = 0.00003) and a significantly higher frequency of adverse postoperative outcomes. Hospital stay was significantly longer in the subgroup with LCOS than in the subgroup without. Multivariate logistic regression analysis identified prolonged QRSd as the most significant predictor of LCOS. LVEF <30%, diuretic therapy, and preoperative risk score (European System for Cardiac Operative Risk Evaluation) were also identified as independent predictors of LCOS. In conclusion, in patients with impaired LV systolic function, prolonged QRSd is a highly significant predictor of LCOS development after isolated CABG.

Simvastatin improves the attenuated heart rate recovery of type 2 diabetics.

Heart rate recovery at 1min (HRR1) is a strong predictor of all-cause mortality. The effects of statins on the autonomic nervous system may account for their beneficial effects in survival. Our aim was to determine if statin therapy improves heart rate recovery in hypercholesterolemic patients with type 2 diabetes mellitus. Thirty type 2 diabetic patients without known coronary artery disease and low density lipoprotein cholesterol>100mg/dl and 30 age and sex matched non-diabetic controls were included in a prospective study. Patients with diabetes were treated with simvastatin 40mg/day for 1 year. No lipid-lowering therapy was administered to the control group. Exercise testing with 2min cool-down period was performed at baseline, 6, 12 weeks and at 1 year. The diabetics had significantly lower HRR1 compared with non-diabetics at baseline (19.2+/-5.4bpm versus 24.2+/-4bpm, p<0.0001). Simvastatin therapy significantly improved HRR1 after 12 weeks compared to baseline (19.2+/-5.4bpm versus 24+/-5bpm, p<0.0001) and this improvement remained significant at 1 year (26+/-4.4bpm, p<0.0001 compared to baseline). HRR1 did not change in the control group (p=0.39 by ANOVA). This study demonstrates that treatment with simvastatin might improve the attenuated heart rate recovery of diabetic subjects. In patients with diabetes, the mortality benefit provided by statins might involve their effects on the autonomic nervous system.

Comparison of direct stenting versus conventional stent implantation on blood flow in patients with ST-segment elevation myocardial infarction.

As compared with balloon angioplasty, stent implantation in treatment of acute myocardial infarction (AMI) reduces abrupt vessel closure, restenosis, and reocclusion rate. However, a few studies have demonstrated the safety and feasibility of direct stenting compared to conventional stent implantation technique. This study was designed to compare possible advantages of direct stenting with conventional stent implantation on immediate coronary blood flow and short-term clinical benefits in patients with AMI. Fifty patients with AMI who underwent mechanical revascularization were eligible for the study. The patients were randomly assigned to undergo either direct stenting (n = 25) or conventional stent implantation (n = 25). Before and after the procedure thrombolysis in myocardial infarction (TIMI) flow and postprocedural corrected TIMI frame count (cTFC) of the infarct-related artery were measured. There was no difference in TIMI flow distribution at baseline between the 2 groups. TIMI 3 flow rate significantly increased after procedure in both groups compared to baseline (p < 0.05). Postprocedural cTFC was found significantly lower in the direct stent arm compared to conventional stenting (p < 0.001). Both during and after the procedure the complication rate and procedural time were lower in the direct stenting arm. Direct stenting provides better immediate coronary blood flow and is a safe and feasible method compared with conventional stenting in patients with AMI. Improvement in coronary blood flow measured by the corrected TIMI frame count method may suggests a significant reduction of microvascular injury.

An experience on radial versus femoral approach for diagnostic coronary angiography in Turkey.

OBJECTIVE: The radial approach has been increasingly used as an alternative to femoral access. The purpose of the present study was to assess the feasibility, success, and safety of the transradial approach (TRA) for diagnostic coronary angiography, and to describe the difficulties associated with the technique as compared with transfemoral approach (TRF). METHODS: A series of 180 consecutive patients were divided to TRA or TFA groups by two operators. We compared the groups regarding procedural time, access time, fluoroscopy time, procedural failure, complications, contrast volume, length of hospital stay, and number of used coronary catheters. RESULTS: The number of used coronary catheters was not different between the two groups (p = 0.6). Total hospital length of stay was significantly shorter in the radial group (p <0.0001) than in femoral one. We found differences between the radial and femoral groups in the success rate (p<0.0001), contrast volume (p = 0.012), procedural time (p<0.0001), access time (p<0.0001), and fluoroscopy time (p<0.0001). We did not find any major complication in the radial group. There was a major bleeding in the femoral group. CONCLUSION: The TRA is a safe alternative to femoral catheterization although with lesser procedural success, longer procedural access, and radiation time, and more contrast volume.

Slow coronary flow is associated with carotid artery dilatation.

Slow coronary flow (SCF) in a normal coronary angiogram is a well-recognized clinical entity, but its etiopathogenesis remains unclear. Carotid intima-media thickness (CIMT) is a noninvasive marker of atherosclerosis. The aim of this study was to investigate the CIMT and diameter of carotid and coronary artery in relation to SCF. Twenty-four patients with angiographically diagnosed SCF (51 +/- 7 years), and 26 age-matched subjects with normal coronary flow (NCF) (52 +/- 8 years) in the coronary angiography were enrolled. Coronary flow rates were documented by thrombolysis in myocardial infarction (TIMI) frame count (TFC), a simple method for evaluating coronary blood flow. Carotid and coronary artery diameters and CIMT were measured. Mean TFC was significantly higher in patients with SCF than in patients with NCF (p < 0.001). There were no significant differences regarding maximum (p = 0.84) and mean CIMT (p = 0.61). On the other hand, carotid lumen (p = 0.03) and coronary artery diameters (p = 0.001) were significantly greater in patients with SCF than in subjects with NCF. There was a significant relation between mean coronary artery diameter and TFC (p = 0.004, 95% CI for OR: 1.61-11.87). In conclusion, these findings suggest that CIMT is not altered in patients with SCF as compared with those with NCF. However, carotid and coronary artery diameters are increased in patients with SCF as compared to those with NCF. Because the common carotid artery can be assessed in nearly every patient, carotid artery dilatation may be used as an early indicator for SCF.

Contribution of plasma lipid disturbances to vascular endothelial function in patients with slow coronary flow.

Previous studies have suggested that microcirculatory abnormalities cause slow coronary flow (SCF). However, the underlying mechanism of this phenomenon has not yet been well documented. Therefore, the aim of this study was to determine the role of plasma lipid disturbances in pathogenesis of slow coronary flow (SCF). Forty patients with SCF (group I) and 37 subjects with normal coronary arteries (group II) were included in the study. In each subject plasma lipid concentrations (total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and triglyceride [TG]) and brachial artery flow-mediated dilatation (FMD) and nitroglycerin (NTG)-induced dilatation were measured. Total cholesterol level was found to be similar in the 2 groups. In group I, HDL-C level was lower than in group II (34 +/-3 vs 40 +/-4 mg/dL, p=0.0001). In group I, TG level was higher than in group II (213 +/-29 vs 198 +/-24 mg/dL p=0.002). In group I, FMD was smaller than that of group II (3.48 +/-3.1% vs 10.4 +/-5.6%, p=0.0001). The percent NTG-induced dilatation was not different between the groups (15.5 +/-5.3% vs 17.3 +/-6.9%, p=0.27). On regression analysis; there was a significant relationship between percent of FMD and HDL-C (r =0.65, p=0.0001). When the 2 groups were analyzed separately, HDL-C was still related to percent of FMD in both groups (r =0.47 p=0.002 and r =0.45 p=0.005, respectively). Multivariate regression analysis showed that only plasma HDL-C was independently related to FMD (F=7.5 p=0.0001). In patients with SCF, reduced flow-mediated dilatation was detected and was found to be associated with plasma lipid disturbances, principally low HDL and high TG levels.

Decreased heart rate recovery in patients with heart failure: effect of fluvastatin therapy.

Heart rate recovery is the difference in heart rate at peak exercise and at a specific time interval following the onset of recovery. Attenuated heart rate recovery is an independent predictor of mortality in patients with a history of coronary artery disease. The aim of the present study was to evaluate the effect of a statin on heart rate recovery, particularly in patients with ischemic heart failure and hyperlipidemia. Twenty-nine consecutive hyperlipidemic, stable coronary artery disease patients with heart failure and 19 healthy subjects were enrolled. Heart rate recovery values at the 1st and 3rd minutes and lipid profiles of the patients were evaluated at baseline and following 3 months of treatment with fluvastatin. Compared with healthy subjects, the heart rate recovery values were significantly lower in the heart failure patients in both the 1st and 3rd minutes, respectively (31 +/- 6 versus 19 +/- 7, P < 0.0001; 66 +/- 7 versus 47 +/- 8, P < 0.0001). Heart rate recovery in the 1st and 3rd minutes increased from 19 +/- 7 to 24 +/- 9 and 47 +/- 8 to 57 +/- 11, respectively, following treatment (P < 0.001, P < 0.001). There were no significant correlations among the changes in lipid parameters or HRR in the first and third minutes in the recovery period. The results revealed an improvement in heart rate recovery in heart failure patients by fluvastatin treatment. If this association can be confirmed by other studies, it would be interesting to perform further studies into the mechanism underlying this finding.