Effect of impaired myocardial contractility on coronary flow reserve and inflammatory processes in chronic coronary syndrome
DOI:
https://doi.org/10.14739/2310-1210.2024.4.305572Keywords:
ischemic heart disease, inflammation, chronic coronary syndrome, stable angina, inflammation biomarkers, endothelial dysfunction, leukocyte inflammation markers, left ventricular ejection fraction, heart failure, obesityAbstract
Aim. To study the relationship between myocardial contractility impairment in chronic coronary syndrome and the state of coronary flow reserve, the degree of systemic inflammation and endothelial dysfunction.
Materials and methods. We examined 120 patients with stable angina pectoris (SAP) of functional class (FC) II–III, who were assigned into two groups: group 1 comprised 65 patients with left ventricular ejection fraction (LVEF) ≥55 %, and group 2 was composed of 55 patients with LVEF <55 %. Diagnostic methods included clinical and instrumental examination data, analyses of lipid profile, inflammation biomarkers, endothelial functional state, hemogram data, leukocyte inflammation markers, and questionnaires.
Results. Compared to group 1, group 2 patients showed an increase in the left atrium (p < 0.001) and right ventricle (p = 0.027) sizes; significantly lower LVEF (50.16 ± 0.42 % vs 58.77 ± 0.41 %; p < 0.001); thickening of the intima-media complex in the right (p = 0.003) and left (p = 0.017) common carotid arteries; significantly lower load threshold values (p = 0.008), exercise tolerance (p = 0.004) and heart rate variability indicators – SDNN (standard deviation of normal-to-normal intervals over 24 hours; p = 0.046).
Group 2 patients were characterized by more active low-grade chronic inflammation, as indicated by increased levels of leukocytes (p = 0.024), neutrophils (p < 0.001), and decreased lymphocyte levels (p = 0.021); significantly higher levels of leukocyte inflammation markers, in particular, the neutrophil-to-lymphocyte ratio (p < 0.001), platelet-to-lymphocyte ratio (p = 0.004), systemic immune-inflammation index (p < 0.001), systemic inflammation response index (p < 0.001), and aggregate index of systemic inflammation (p < 0.001) as compared to group 1 individuals. Patients with LVEF <55 % had higher levels of fibrinogen (p < 0.001), uric acid (p = 0.002), high-sensitivity C-reactive protein (p = 0.007), and endothelin-1 (p < 0.001) compared to those with LVEF ≥55 %.
Conclusions. Group 2 patients need a more thorough monitoring and a more intensive treatment aimed at reducing the inflammatory process.
References
Waksman R, Merdler I, Case BC, Waksman O, Porto I. Targeting inflammation in atherosclerosis: overview, strategy and directions. EuroIntervention. 2024;20(1):32-44. doi: https://doi.org/10.4244/EIJ-D-23-00606
Marchi F, Pylypiv N, Parlanti A, Storti S, Gaggini M, Paradossi U, et al. Systemic Immune-Inflammation Index and Systemic Inflammatory Response Index as Predictors of Mortality in ST-Elevation Myocardial Infarction. J Clin Med. 2024;13(5):1256. doi: https://doi.org/10.3390/jcm13051256
Attiq A, Afzal S, Ahmad W, Kandeel M. Hegemony of inflammation in atherosclerosis and coronary artery disease. Eur J Pharmacol. 2024;966:176338. doi: https://doi.org/10.1016/j.ejphar.2024.176338
Ridker PM, Bhatt DL, Pradhan AD, Glynn RJ, MacFadyen JG, Nissen SE, et al. Inflammation and cholesterol as predictors of cardiovascular events among patients receiving statin therapy: a collaborative analysis of three randomised trials. Lancet. 2023;401(10384):1293-301. doi: https://doi.org/10.1016/S0140-6736(23)00215-5
Liu Y, Song J, Wang W, Zhang K, Qi Y, Yang J, et al. Association of ejection fraction with mortality and cardiovascular events in patients with coronary artery disease. ESC Heart Fail. 2022;9(5):3461-8. doi: https://doi.org/10.1002/ehf2.14063
Harkness A, Ring L, Augustine DX, Oxborough D, Robinson S, Sharma V. Education Committee of the British Society of Echocardiography. Normal reference intervals for cardiac dimensions and function for use in echocardiographic practice: a guideline from the British Society of Echocardiography. Echo Res Pract. 2020;7(1):G1-G18. doi: https://doi.org/10.1530/ERP-19-0050
Kovalenko V, Dolzhenko M, Potashev S. Nastanovy z klinichnoi ekhokardiohrafii [Guidelines for clinical echocardiography]. Kyiv: Naukova dumka; 2018. Ukrainian.
Preda A, Carbone F, Tirandi A, Montecucco F, Liberale L. Obesity phenotypes and cardiovascular risk: From pathophysiology to clinical management. Rev Endocr Metab Disord. 2023;24(5):901-19. doi: https://doi.org/10.1007/s11154-023-09813-5
Albricker AC, Freire CM, Santos SN, Alcantara ML, Cantisano AL, Porto CL, et al. Recommendation Update for Vascular Ultrasound Evaluation of Carotid and Vertebral Artery Disease: DIC, CBR and SABCV - 2023. Arq Bras Cardiol. 2023;120(10):e20230695. English, Portuguese. doi: https://doi.org/10.36660/abc.20230695
Poredos P, Jezovnik MK. Preclinical carotid atherosclerosis as an indicator of polyvascular disease: a narrative review. Ann Transl Med. 2021;9(14):1204. doi: https://doi.org/10.21037/atm-20-5570
Kim DY, Kim SE, Park TK, Choi KH, Lee JM, Yang JH, et al. Elevated white blood cell count and long-term clinical outcomes of patients with vasospastic angina. Coron Artery Dis. 2024;35(5):382-8. doi: https://doi.org/10.1097/MCA.0000000000001359
Zhao Q, Liu R, Chen H, Yang X, Dong J, Bai M. White blood cells and coronary heart disease: A mendelian randomization study. Front Genet. 2023;14:1127820. doi: https://doi.org/10.3389/fgene.2023.1127820
Gong S, Gao X, Xu F, Shang Z, Li S, Chen W, et al. Association of lymphocyte to monocyte ratio with severity of coronary artery disease. Medicine (Baltimore). 2018;97(43):e12813. doi: https://doi.org/10.1097/MD.0000000000012813
Azab B, Zaher M, Weiserbs KF, Torbey E, Lacossiere K, Gaddam S, et al. Usefulness of neutrophil to lymphocyte ratio in predicting short- and long-term mortality after non-ST-elevation myocardial infarction. Am J Cardiol. 2010;106(4):470-6. doi: https://doi.org/10.1016/j.amjcard.2010.03.062
Delcea C, Buzea CA, Dan GA. The neutrophil to lymphocyte ratio in heart failure: a comprehensive review. Rom J Intern Med 2019;57(4):296-314. doi: https://doi.org/10.2478/rjim-2019-0018
Dziedzic EA, Gąsior JS, Tuzimek A, Dąbrowski M, Jankowski P. Neutrophil-to-Lymphocyte Ratio Is Not Associated with Severity of Coronary Artery Disease and Is Not Correlated with Vitamin D Level in Patients with a History of an Acute Coronary Syndrome. Biology (Basel). 2022;11(7):1001. doi: https://doi.org/10.3390/biology11071001
Li Q, Ma X, Shao Q, Yang Z, Wang Y, Gao F, et al. Prognostic Impact of Multiple Lymphocyte-Based Inflammatory Indices in Acute Coronary Syndrome Patients. Front Cardiovasc Med. 2022;9:811790. doi: https://doi.org/10.3389/fcvm.2022.811790
Liu Y, Ye T, Chen L, Jin T, Sheng Y, Wu G, Zong G. Systemic immune-inflammation index predicts the severity of coronary stenosis in patients with coronary heart disease. Coron Artery Dis. 2021;32(8):715-20. doi: https://doi.org/10.1097/MCA.0000000000001037
Jin Z, Wu Q, Chen S, Gao J, Li X, Zhang X, et al. The Associations of Two Novel Inflammation Indexes, SII and SIRI with the Risks for Cardiovascular Diseases and All-Cause Mortality: A Ten-Year Follow-Up Study in 85,154 Individuals. J Inflamm Res. 2021 Jan 18;14:131-140. doi: https://doi.org/10.2147/JIR.S283835
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
