Original ArticleAbnormal glucose and lipid control in non-ischemic left ventricular dysfunction
Introduction
The growing diffusion of cardiac positron emission tomography (PET) has provided new information on myocardial blood flow (MBF) regulation in different clinical conditions. Specifically, a reduced MBF at rest and during hyperemia has been increasingly correlated with factors affecting coronary function more than with the “traditional” effects of coronary stenoses.1,2 In subjects with normal coronary arteries and preserved left ventricular (LV) function, cardiovascular (CV) risk factors have been associated with depressed MBF and flow reserve.1,3 In patients with coronary artery disease (CAD), depressed global MBF has been correlated with global CV risk burden more than coronary anatomy.4 Finally, in patients with suspected CAD, a globally depressed MBF at rest and during stress has resulted the main independent predictor of adverse prognosis, overwhelming other common risk factors.5
The depression of global MBF at rest and during hyperemia has been also described by PET in patients with idiopathic LV dysfunction,6 carrying relevant prognostic information.7,8 Several factors have been proposed as possible determinants of altered myocardial perfusion in these patients, including the mechanical effects of myocardial contractile and hemodynamic impairment on coronary circulation, reduced capillary density, and primary microvascular dysfunction.1,9 Despite some evidence that traditional CV risk factors may occur frequently in this population10,11 and that coronary endothelial function may be impaired,12 the possible relationship between MBF abnormalities and CV risk factors has never been explored in these patients.
With these considerations in mind, we undertook this study to investigate whether CV risk factors, classically associated with CAD, are also predictors of a more severe LV dilatation and systolic impairment and of depressed MBF in patients with non-ischemic LV dysfunction.
Section snippets
Patients
We studied a group of 81 patients with different degrees of non-ischemic LV dysfunction, admitted to our Institute between 1999 and 2009. Inclusion criteria were between 20 and 80 years of age, LV ejection fraction ≤50% by two-dimensional echocardiography, normal coronary arteries or minimal luminal irregularities (<30% luminal diameter reduction) at angiography, and stable clinical conditions. Exclusion criteria were previous myocardial infarction, ≥moderate valvular heart disease, severe
Study Patients
The characteristics of patients as a whole or divided into two groups according to the presence of overt LV dilatation and systolic dysfunction are summarized in Table 1. The study population included mainly males, without overt heart failure (NYHA functional class I-II in 81% of cases) with prevalence of multiple CV risk factors. Patients with overt LV dilatation and dysfunction differed from the remaining patients because of a higher fasting plasma glucose and HOMA index, higher prevalence of
Discussion
This study shows that low HDL-C and NIDD/IR are associated with more severe LV dilatation and contractile impairment, and with more depressed MBF during stress in patients with non-ischemic LV dysfunction.
Acknowledgments
We thank Elisa Rizza and Stefano Masi for helping collecting the data. We also thank Silvia Pardini and Danilo Bonora for the production of 13N-Ammonia and Alison Frank for helping editing the manuscript. This study was partly supported by the Genocor FIRB 2005 project of the Italian Ministry of Education, University and Research (Grant N. RBLA05ACJZ).
Conflicts of interest
The authors have indicated that they have no financial conflicts of interest.
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