Cho et al., 2009 Journal of Cardiology (2009), 54:

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Endothelial Dysfunction, Increased Carotid Artery Intima-media Thickness and Pulse Wave Velocity, and Increased Level of Inflammatory Markers

1 Endothelial Dysfunction, Increased Carotid Artery Intima-media Thickness and Pulse Wave Velocity, and Increased Level of Inflammatory Markers are Associated with Variant Angina Cho et al., 2009 Journal of Cardiology (2009), 54: Presented by Suphawadee Phababpha 15 th December 2009

2 1. Introduction 2. Materials & methods 3. Results & Discussion

4 Percentage of Deaths (All ages) Male West Midlands by cause

shortness of breath during exercise, and heart

5 What is Coronary artery disease (CAD)? : is a narrowing or blockage of the coronary arteries : leads to an imbalance between oxygen supply and demand : it results chest pain, shortness of breath during exercise, and heart attack which finally lead to sudden death in general population 3

6 What is Angina? is chest pain or discomfort that occurs when an area of your heart muscle doesn't get enough oxygen-rich blood. The pain also may occur in your shoulders, arms, neck, jaw, or back. It can feel like indigestion.

7 Types of Angina Stable Angina The pain usually goes away in a few minutes after you rest or take your angina medicine. Unstable Angina Unstable angina doesn't follow a pattern. It can occur with or without physical exertion and isn't relieved by rest or medicine. Variant Angina (VA) It is caused by vasospasm, a narrowing of the coronary artery caused by contraction of the smooth muscle tissue in the vessel walls rather than directly by atherosclerosis.

Endothelial dysfunction was occurred in VA patients by reduced promoter

8 Endothelial dysfunction might be involved in the development of coronary vasospasm and the progression of atherosclerosis. Endothelial dysfunction was occurred in VA patients by reduced promoter activity of the endothelial NO synthesis gene and predisposes the patients with the mutation to coronary spasm.

10 NO Antiatherogenic property Inhibit Inflammatory mechanism Inhibit platelet Aggregation And adhesion Inhibit vascular permeability Inhibit Smooth muscle cell proliferation Inhibit Leukocyte adhesion

11 Cardiovascular risk factors Hypercholesterolemia Hypertension Diabetes mellitus Smoking Menopause Endothelial dysfunction Family history of CVD Obesity

12 Endothelial function measurement (Guerci et al., Diabetes Metab 2001; 27: )

13 Objective of this study To investigate whether endothelial dysfunction and atherosclerosis are related to VA in Korean patients.

15 Subjects 254 patients (150 men and 104 women with chest pain) VA patients (n=76) match Control (n=58) CAD patients (n=120) Presence of chest pain associated with ST segment elevation Ergonovine provocation test is positive Ergonovine provocation test is negative No significant of coronary stenosis Exertional chest pain Positive results on exercise stress test and/or stress myocardial perfusion imaging No significant of coronary stenosis Significant coronary stenosis Significant coronary stenosis was defined as >50% stenosis of the major coronary arteries.

Ergonovine provocation test (EPT) Coronary Angiography Ergonovine maleate were infused into left coronary artery (5, 10, and 30 ug/min) for 3 min with 2 min intervals between consecutive

16 Ergonovine provocation test (EPT) Coronary Angiography Ergonovine maleate were infused into left coronary artery (5, 10, and 30 ug/min) for 3 min with 2 min intervals between consecutive doses coronary spasm Nitroglycerin (200ug) was given as an intra-coronary injection A positive ergonovine-provocation test was defined as >90% focal reduction in the diameter of coronary arteries.

17 Flow-mediated dilation (FMD) Protocol 1 Baseline occlusion 5 min post occlusion Protocol 2 Rest 10 min Baseline 0.6 mg of nitroglycerin (SL) record

18 Systemic atherosclerotic measurement Carotid intima-media thickness (IMT)

19 Brachial-ankle pulse wave velocity (bapwv) bapwv = Distance Time

20 254 patients (150 men and 104 women with chest pain) FMD, bapwv and carotid IMT WBC counts, monocyte counts, hscrp, homocysteine, fibrinogen, HbA1C and lipid profile Coronary Angiography

21 Statistical analysis The results are expressed as means ± SD Scheffe s test Best-fit test One way analysis of variance Statistical significance is set at P < 0.05

IL-6 was associated with diagnosis of coronary vasospastic angina pectoris in

25 hscrp was independent marker of coronary vasospasm in patients who had no hemodynamically significant CAD. IL-6 was associated with diagnosis of coronary vasospastic angina pectoris in patients without hemodynamically significant CAD. Endothelial dysfunction in this setting may be attributable to state of systemic inflammation.

26 nitroglycerine Smooth muscle cell Vasodilatation

27 L-NMMA - enos NO Vasodilation Endothelial NO-mediated flowdependent dilation is impaired in spasm coronary arteries and that this impairment may play an important role in the pathophysiology of coronary artery spasm in patients with coronary spastic angina.

29 Coronary vasospasm is closely related to atherosclerotic coronary artery disease. bapwv correlates with the carotid IMT, which is marker of the severity of atherosclerosis.

30 Conclusions: Endothelial Dysfunction FMD Atherosclerosis bapwv and carotid IMT Inflammation WBC, monocyte counts VA patients FMD, carotid IMT, bapwv and inflammatory markers may present targets for the development of novel antiinflammatory marker drugs in VA patients.

31 Small of sample size hscrp was checked once before coronary angiogram, not serial follow-up Functional analysis of monocytes was not performed They did not perform ergonovine provocation test in CAD patients

32 Assoc. Prof. Upa Kukongviriyapan Assist. Prof. Poungrat Pakdeechote

34 Cardiovascular risk factors Diabetes FBG 126 mg/dl or post-prandial 2 h blood glucose values of 200 mg/dl or receiving oral hyperglycemic agents or insulin Hypertension BP 140/90 mmhg or receiving antihypertensive medications Dyslipidemia Total cholesterol 220 mg/dl LDL cholesterol 140 mg/dl Smoking Who are smoking currently or stopped smoking within 3 months

Coronary Heart Disease. Raja Nursing Instructor RN, DCHN, Post RN. BSc.N

Coronary Heart Disease. Raja Nursing Instructor RN, DCHN, Post RN. BSc.N Coronary Heart Disease Raja Nursing Instructor RN, DCHN, Post RN. BSc.N 31/03/2016 Objectives Define coronary heart disease (CHD). Identify the causes and risk factors of CHD Discuss the pathophysiological