New insights to the potential mechanisms driving coronary flow reserve impairment in Cushing's syndrome : A pilot noninvasive study by transthoracic Doppler echocardiography
Copyright © 2019 Elsevier Inc. All rights reserved..
BACKGROUND: The contribution of functional and/or structural remodeling to reduced coronary flow velocity reserve (CFVR), reflecting impaired coronary microcirculation in Cushing's syndrome (CS), has not been clearly elucidated. We aimed to identify the potential mechanisms of coronary microvascular impairment in CS.
METHODS: We studied 15 CS patients (11 female, age 50 ± 9 years) without clinical evidence of cardiovascular disease. Coronary flow velocity in the left anterior descending coronary artery was measured by transthoracic Doppler echocardiography, at rest, and during adenosine infusion. Average peak flow velocities, CFVR, and microvascular resistance in baseline (BMR) and hyperemic conditions (HMR) were assessed. CFVR ≤2.5 was considered a marker of microvascular disease (CMD). Diastolic function (E/e'), global longitudinal strain (GLS) and fractional pulse pressure (fPP), an index of arterial stiffness, were also assessed.
RESULTS: CMD was present in 5 patients (33.3%). CMD was primarily driven by increased baseline peak flow velocity (29 ± 12 versus 19.6 ± 4.2 cm/s, p = .03) in the presence of decreased BMR (3.62 ± 0.6 versus 5.46 ± 1.4 mm Hg·s/cm, p = .03). Moreover, urinary cortisol and E/e' were higher (p = .001 and p = .001, respectively) and GLS was lower (p = .009) in patients with CMD. fPP was higher in patients with CMD (p = .01). Urinary cortisol correlated to CFVR (p = .008), E/e' (p < .0001) and GLS (p < .0001). fPP directly correlated to average peak flow velocities at rest (p = .01) and inversely to BMR (p = .03).
CONCLUSIONS: Functional microvascular regulatory impairment seems to be the potential mechanism of CMD in CS. CMD seems to be related to decreased myocardial contractility and diastolic dysfunction associated with cortisol excess.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:128 |
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| Enthalten in: |
Microvascular research - 128(2020) vom: 01. März, Seite 103940 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Tona, Francesco [VerfasserIn] |
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| Links: |
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| Themen: |
Coronary flow |
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| Anmerkungen: |
Date Completed 28.07.2020 Date Revised 28.07.2020 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.mvr.2019.103940 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM30282734X |
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| 245 | 1 | 0 | |a New insights to the potential mechanisms driving coronary flow reserve impairment in Cushing's syndrome |b A pilot noninvasive study by transthoracic Doppler echocardiography |
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| 500 | |a Date Revised 28.07.2020 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2019 Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: The contribution of functional and/or structural remodeling to reduced coronary flow velocity reserve (CFVR), reflecting impaired coronary microcirculation in Cushing's syndrome (CS), has not been clearly elucidated. We aimed to identify the potential mechanisms of coronary microvascular impairment in CS | ||
| 520 | |a METHODS: We studied 15 CS patients (11 female, age 50 ± 9 years) without clinical evidence of cardiovascular disease. Coronary flow velocity in the left anterior descending coronary artery was measured by transthoracic Doppler echocardiography, at rest, and during adenosine infusion. Average peak flow velocities, CFVR, and microvascular resistance in baseline (BMR) and hyperemic conditions (HMR) were assessed. CFVR ≤2.5 was considered a marker of microvascular disease (CMD). Diastolic function (E/e'), global longitudinal strain (GLS) and fractional pulse pressure (fPP), an index of arterial stiffness, were also assessed | ||
| 520 | |a RESULTS: CMD was present in 5 patients (33.3%). CMD was primarily driven by increased baseline peak flow velocity (29 ± 12 versus 19.6 ± 4.2 cm/s, p = .03) in the presence of decreased BMR (3.62 ± 0.6 versus 5.46 ± 1.4 mm Hg·s/cm, p = .03). Moreover, urinary cortisol and E/e' were higher (p = .001 and p = .001, respectively) and GLS was lower (p = .009) in patients with CMD. fPP was higher in patients with CMD (p = .01). Urinary cortisol correlated to CFVR (p = .008), E/e' (p < .0001) and GLS (p < .0001). fPP directly correlated to average peak flow velocities at rest (p = .01) and inversely to BMR (p = .03) | ||
| 520 | |a CONCLUSIONS: Functional microvascular regulatory impairment seems to be the potential mechanism of CMD in CS. CMD seems to be related to decreased myocardial contractility and diastolic dysfunction associated with cortisol excess | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Coronary flow | |
| 650 | 4 | |a Coronary flow reserve | |
| 650 | 4 | |a Coronary microcirculation | |
| 650 | 4 | |a Coronary microvascular resistance | |
| 650 | 4 | |a Cortisol | |
| 650 | 4 | |a Cushing's syndrome | |
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| 700 | 1 | |a Barbot, Mattia |e verfasserin |4 aut | |
| 700 | 1 | |a Maritan, Luca |e verfasserin |4 aut | |
| 700 | 1 | |a Famoso, Giulia |e verfasserin |4 aut | |
| 700 | 1 | |a Dal Lin, Carlo |e verfasserin |4 aut | |
| 700 | 1 | |a Montisci, Roberta |e verfasserin |4 aut | |
| 700 | 1 | |a Fallo, Francesco |e verfasserin |4 aut | |
| 700 | 1 | |a Iliceto, Sabino |e verfasserin |4 aut | |
| 700 | 1 | |a Scaroni, Carla |e verfasserin |4 aut | |
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