1 / 25

Endothelial Dysfunction as a Marker of Cardiovascular Events Robert A. Vogel, M.D.

Endothelial Dysfunction as a Marker of Cardiovascular Events Robert A. Vogel, M.D. “Response-to-Injury” Hypothesis. Genes. Coronary Risk Factors. Endothelial Dysfunction  NO ↑ Inflammation ↑ Thrombosis. Coronary Heart Disease.

Download Presentation

Endothelial Dysfunction as a Marker of Cardiovascular Events Robert A. Vogel, M.D.

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Endothelial Dysfunction as a Marker of Cardiovascular EventsRobert A. Vogel, M.D.

  2. “Response-to-Injury” Hypothesis Genes Coronary Risk Factors Endothelial Dysfunction NO ↑Inflammation ↑Thrombosis Coronary Heart Disease

  3. Regulatory Functions of the EndotheliumNormal Dysfunction Vasodilation Vasoconstriction NO, PGI2, EDHF, BK, C-NP ROS, ET-1, TxA2, A-II, PGH2 Thrombolysis Thrombosis tPA, Protein C, TF-I, vonWF PAI-1, TF, Tx-A2 Platelet Disaggregation NO, PGI2 Adhesion Molecules CAMs, Selectins Antiproliferation NO, PGI2, TGF-, Hep Growth Factors ET-1, A-II, PDGF, bFGF, ILGF, Interleukins Lipolysis Inflammation ROS, NF-B LPL Vogel R

  4. Fichtlscherer S et al, Circulation 2000;102;1000Comparison of Forearm Responses to ACh and C-Reactive Protein in 60 Men with CAD

  5. Cayette et al, Nature 1990; Cooke et al, JCI 1992;90:1168Effect of NO Inhibition and Augmentation on Hypercholesterolemic Rabbit Aortic Atherosclerosis Area at 6 Weeks L-NAME L-Arginine Control

  6. Coronary Arteries Epicardial Artery Diameter  with ACh CBF  with ACh Epicardial Artery Diameter  with Adenosine Forearm Brachial Artery Diameter  with Arterial Occlusion Forearm Blood Flow with ACh Clinical Methods for Assessing Endothelium-Dependent Dilation

  7. Takese B, Am J Cardiol 1998:82:1535Comparison of Brachial and Coronary Flow-Mediated Vasodilation

  8. Furchgott RF & Zawadski JV, Nature 1980 Anderson TJ et al, NEJM 1995;332:488

  9. Schachinger V et al, Circulation 2000;101:1899CVE’s over 7.7 Years in 147 Subjects with CAD According to Coronary Artery Responses to Ach, Cold Pressor, and FMD CVE’s

  10. Halcox JPJ et al, Circulation 2002;106:653CVE’s over 4 Years in 176 Subjects without CAD According to CVR and CA Diameters Changes with ACh

  11. Al Suwaidi J et al. Circulation 2000;101:948Cardiac Events in 157 CAD Patients over 28 Months Stratified by CBF Responses to ACh

  12. Targonski PV et al, Circulation 2003;107:2805Relative Risk of CVA or TIA in 503 Non-Obstructive CAD Subjects over 88 Months According to CBR Responses to ACh Relative Risk of CVA/TIA CBF Increase with ACh

  13. Coronary Arteries Epicardial Artery Diameter  with ACh CBF  with ACh Epicardial Artery Diameter  with Adenosine Forearm Brachial Artery Diameter  with Arterial Occlusion Forearm Blood Flow with ACh Clinical Methods for Assessing Endothelium-Dependent Dilation

  14. Perticone F et al, Circulation 2001;104:191Effect of ACh-Induced Forearm Vasodilation* on 32-Month CVE’s (%) in 225 Never Treated Hypertensive Subjects(* Relative Flow Increase)

  15. Heitzer T et al, Circulation 2001;104:2673CVE’s According to FBF Responses to ACh and I.V. Vitamin C in 281 Subjects with CHD ACh-induced FBF Responses Vitamin C Responses

  16. Brachial Artery Flow-Mediated VasodilationBaseline5 MinutesPost-OcclusionBlood Pressure Cuff Occlusion – 1 Minute Release 3.6 mm 3.1 mm

  17. Neuntfeufl T et al, Am J Cardiol 2000;86:207CHD Events over 5 Years in 76 CAD Patients According to Brachial Artery FMD

  18. Murakami T et al. J Am Coll Cardiol 2001;37:294ACVE’s over 4 Years in 480 Patients with Suspected CAD According to Brachial Artery FMD

  19. Endothelial Dysfunction as a Therapeutic Prognosticator

  20. Gokce N et al, Circulation 2002;105:1567Effect of Preoperative FMD on 30-Day MACE and MACE + Elevated Troponin in 187 Patients Undergoing Vascular Surgery

  21. Sorensen KE et al, Circulation1998:97:1234Effect of HRT on Brachial Artery FMD at 3 Years in 100 Postmenopausal Women Randomized to HRT/Placebo and 30 Premenopausal Women

  22. Modena MG et al. J Am Coll Cardiol 2002;40:5055-Year Outcome in 350 Postmenopausal Hypertensive Women with Controlled BP (<140/90) Based on the Change in Brachial Artery Flow-Mediated Vasodilation during the First 6 Months of Treatment(Similar initial FMD values, treatment, and on-treatment BP)  

  23. FMD and LDL-C at Baseline and 3 Months in the REVERSAL Trial 15% 10% 5% 0% 3 Months Flow-Mediated Dilation Baseline Pravastatin 40 mg Atorvastatin 80 mg 75 100 125 150 175 LDL-C (mg/dl)

  24. % Change in IVUS Atheroma Volume at 18 Months in the REVERSAL Trial Percent Change in Atheroma Volume by IVUS P = 0.02 LDL-C 110 LDL-C 79 Pravastatin 40 mg Atorvastatin 80 mg

  25. Summary: Coronary and brachial artery endothelium-mediated dilation provide significant CVE prognostic information and may be indexes of therapeutic responses.

More Related