Microcirculation; Biomarkers; Myocardial Ischemia
Conditions
Brief summary
Cardiovascular diseases (CVD) are responsible, throughout the world, for high mortality rates and cardiovascular morbidity. Endothelial dysfunction is the earliest marker of clinical atherosclerosis development. Human studies show that endothelial and microvascular dysfunction are independent predictors of ischemic cardiovascular events and long-term prognosis. The study´s objective is to evaluate the endothelial and peripheral microcirculation changes by venous occlusion plethysmography (VOP), nailfoldvideocapillaroscopy (NVC) and serum biomarkers in patients with myocardial ischemia detected by scintigraphy and normal coronarography.
Detailed description
A cross-sectional study was carried out with 50 participants: 25 with myocardial ischemia detected by scintigraphy and normal coronarography (Ischemic Patient - IP) and 25 healthy non-ischemic individuals (Control Group - CG). All of them were submitted to anamnesis, serum markers (Intercellular Cell Adhesion Molecule \[ICAM\], Vascular Cell Adhesion Molecule\[VCAM\], adiponectin, endothelin, LDL-oxidized and CRP-US), NVC and VOP. Exclusion criteria were: inflammatory diseases, cancer patients, recent traumas, Diabetes Mellitus, obese individuals with BMI\> 35 kg/m², uncontrolled hypertensive patients, and those with active infectious processes. In the NVC,capillary diameters were observed, as well as red blood cells velocity in the capillaries (RBCV, mm/s), maximum red blood cells after 1 minute ischemia (RBCVmax, mm/s) and time to reach maximal velocity (TRBCVmax) and, regarding VOP,the baseline blood flow (ml/min), post 5 minute ischemia flow and vascular resistance (mmHg/ml/min) were evaluated. Data were analyzed using Student's t-tests for independent or Mann-Whitney samples; χ2 or Fisher exact. The absolute and relative variations (delta) of plethysmography measurements versus baseline in each group were analyzed by the Wilcoxon signed-ranks test and compared between the groups by the Mann-Whitney test. For correction of confounding factors, age and BMI, it was used Covariance Analysis (ANCOVA).
Interventions
None listed
Sponsors
Camillo L.C. Junqueira
Esmeralci Ferreira
Maria das Graças C. Souza
Eliete Bouskela
Rio de Janeiro State University
Study design
Observational model
OTHER
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
The study population consisted of 50 patients of both sexes, stratified into two groups: patients with myocardial ischemia detected by scintigraphy (group IP, n = 25) and healthy individuals (CG group, n = 25). In the patients who underwent scintigraphy with tomographic sections and presented any type of image attenuation during the examination, they also underwent a complementary prone position technique. Patients without these characteristics scintigraphy methodologies were excluded from the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| %Hyper | One year | Increment of forearm blood flow during reactive hyperemia after 5 minutes arm ischemia with venous occlusion plethysmography. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intercellular adhesion molecule (ICAM) | One year | Inflammatory biomarker obtained through withdrawal of venous blood. |
| Vascular adhesion molecule (VCAM) | One year | Inflammatory biomarker obtained through withdrawal of venous blood. |
| Adiponectin | One year | Adipokyne obtained through withdrawal of venous blood. |
| Endothelin | One year | Potent vasoconstrictor obtained through withdrawal of venous blood. |
| LDL-oxidized | One year | Low density lipoprotein oxidized used to measure oxidative stress. It is obtained from venous blood. |
| CRP | One year | C reactive protein obtained through withdrawal of venous blood. |
| % Nitro | One year | Increment of forearm blood flow after 5 minutes of 400 μg sublingual nitroglycerin application with venous occlusion plethysmography.. |
| %ResHyper | One year | Increment of vascular resistance during reactive hyperemia after 5 minutes arm ischemia with venous occlusion plethysmography. |
| AFCD | One year | Afferent capillar diameter. Obtained from Nailfold videocapillaroscopy. |
| ACD | One year | Apical capillar diameter. Obtained from Nailfold videocapillaroscopy. |
| EFCD | One year | Efferent capillar diameter. Obtained from Nailfold videocapillaroscopy. |
| RBCV | One year | Basal red blood cell velocity. Obtained from Nailfold videocapillaroscopy. |
| RBCVmax | One year | Maximum red blood cell velocity during reactive hyperemia in fourth finger after one minute ischemia. Obtained from Nailfold videocapillaroscopy. |
| TRBCVmax | One year | Time to reach Maximum red blood cell velocity during reactive hyperemia in fourth finger after one minute ischemia. Obtained from Nailfold videocapillaroscopy. |
| %ResNitro | One year | Increment of vascular resistance after 5 minutes of 400 μg sublingual nitroglycerin application with venous occlusion plethysmography. |
| FCD | One year | Functional capillary density. Number of capillaries with flowing red blood cell in microscope area. Obtained from Nailfold videocapillaroscopy. |
Outcome results
None listed