Giovanna Evola

Impact of insulin resistance on cardiac and vascular function.

BACKGROUND Insulin resistance (IR), constitutes an important cardiovascular risk factor and can cause ischemic heart disease. It can lead to left ventricular dysfunction with a mechanism independent of ischemic heart disease and it is closely associated with impaired vascular function. The aim of our study was to explore the impact of IR on cardiac and vascular function, in patients with cardiovascular risk factors but angiographically undamaged coronary arteries. METHODS We studied 32 patients (62.06±11.19years) with cardiovascular risk factors. All patients underwent coronary angiography, echocardiography, Doppler ultrasound of carotid arteries and laboratory tests. Exclusion criteria were coronary artery disease detected by coronary angiography, diabetes mellitus, creatinine above 1.5mg/dl, atrial fibrillation or malignant arrhythmias, left-ventricular hypertrophy, valvular heart disease, ejection fraction below 50%. The presence of insulin resistance was assessed using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Each patient underwent a complete echocardiographic examination including Global Longitudinal Strain assessment and carotid artery ultrasound scan including measurement of arterial stiffness. RESULTS The patients were divided into two groups based on the median value of HOMA-IR, the first group for values <4.14 and, the second, for values ≥4.14. Ejection fraction and diastolic function did not significantly differ between the two groups, whether in patients with higher levels of HOMA-IR (≥4.14) we observed a Global Longitudinal Strain (GLS) that was significantly reduced (-16.50±1.37% vs. -20.73±1.84%, p=0.0015) vascular stiffness, measured in the carotid arteries as pulse wave velocity (PWV) (9.70±1.75m/s vs. 7.40±1.89m/s, p=0.00148) that was increased. At multivariate analysis HOMA-IR was an independent predictor of myocardial dysfunction (GLS: coefficient 0.1156, p<0.0001). CONCLUSION Insulin resistance is associated with subclinical myocardial and vascular alterations in patients without significant coronary artery disease, measured as a reduction of Global Longitudinal Strain, and increased arterial stiffness. Our results underscore the importance of studying the interaction between ventricular function and vessels, in the perspective of more effective preventive and therapeutic interventions.

The role of macrophage colony-stimulating factor in patients with acute myocardial infarction: a pilot study.

We assessed whether macrophage colony-stimulating factor (M-CSF) levels are associated with left ventricular systolic dysfunction (LVSD) in patients with acute myocardial infarction (AMI). We studied 56 patients with AMI (mean age: 67 ± 12 years) and identified those with clinical (Killip class >II) or echocardiographic signs (ejection fraction ≤45%) of LVSD. We evaluated the established cardiovascular risk factors and measured several cardiovascular biomarkers, including M-CSF. Serum M-CSF concentrations (pg/mL) were significantly increased in patients with both clinical and echocardiographic signs of LVSD (460 ± 265 vs 290 ± 210, P = .0103 and 493 ± 299 vs 287 ± 174, P = .0028, respectively). We found a significant inverse association between M-CSF and ejection fraction (r = −.351, P = .0079). Logistic regression analysis revealed that, among all evaluated clinical and biochemical parameters, the stronger predictor of LVSD was M-CSF (odds ratios 2.1, 95% confidence interval 1.1-2.9, P = .0168). This is the first study reporting plasma M-CSF levels as independent determinants of low LV ejection fraction and clinical LV dysfunction in patients with AMI.

MATRIX METALLOPROTEINASES AND CORONARY ARTERY ECTASIA.

PieroLevantino, Massimo Raspanti, Salvatore Evola, Giuseppina Novo, Giovanna Evola and Salvatore Novo. University Hospital P. Giaccone Department Of Cardiology, Palermo, Italy. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

Atrial Fibrillation and Metabolic Syndrome: Correlation or Simple Coincidence?

Background: The atrial fibrillation (AF) is the iperkinetic arhytmia most frequently encountered in the general population. Metabolic Syndrome (MS) is a condition characterized by a set of cardiovascular risk factors that include: abdominal obesity, hypertension, impaired fast glucose, elevated tryglicerides and low HDL-C. We set out to analyze the impact of the MS has on our population looking to explain the reasons for the possible correlation with AF. Methods: MS was defined according to the definition of the guidelines of NCEP-ATP III. 350 patients were enrolled in the Department of Cardiology of our University Polyclinic of Palermo. Among these patients, 149 (42.57%) had Paroxysmal Atrial Fibrillation (PAF) and 201 (57.42%) had Chronic Atrial Fibrillation (CAF). We had two groups, the first 170 patients (48.57%) with AF and MS, and the second 180 patients (51.42%) with AF but without MS. Results: In our population, there is not a significant difference in the prevalence of hypertension between group with MS and group without MS (p=0.52), while there is a significant difference in prevalence between the two groups in relation to other variables as overweight/obesity, hyperglycemia, hypertryglicerydemia and low HDL-C (p<0.0001). Conclusions: Our results lead us to think that metabolic and hormonal disorder may be important in the pathogenesis of the CAF and in the maintenance of the arythimia, although by mechanisms not yet completely known. Inflammation and oxidative stress important for the MS have been proposed as etiologic factors also implicated in the pathogenesis of AF or at least maintaining.