Potential marker of endothelial dysfunction in patients with various grade of cardiovascular risk
https://doi.org/10.15829/1728-8800-2016-2-57-62
Abstract
Aim. As the endothelial glycocalix (EG) — gel-like layer on the surface of endothelium, participates in normal endothelial functioning maintenance, search for markers that characterize its condition, is of high scientific interest. Aim of the study — to evaluate clinical and diagnostic opportunities for novel EG marker, related to thickness and plasticity of EG, represented as perfused boundary region (PBR, μm) of erythrocytes.
Material and methods. Totally, 208 patients included (123 men, 85 women) at the age 40-65 y.o., with various level of cardiovascular risk by SCORE, and coronary heart disease (CHD). EG of microvessels was charterized via PBR, that was measured with dark field capillaroscope with diod light of green spectrum.
Results. With the values of PBR >2 μm there is worsening of morphofunctional state of arteries of different localizations, and microcirculatory vessels, level of apolipoprotein A1 decreases, as structure protein of high density lipoproteins, and prevalence of carotid atherosclerosis increases two times, of CHD — 2,5 times (p<0,05). Tendency is marked to the increase of prevalence of higher cardiovascular risk by SCORE. Statins intake in CHD patients is related to PBR decrease: 1,86±0,20 μm vs 2,05±0,22 μm (p<0,05).
Conclusion. Novel marker of EG, PBR, in values >2 μm, is associated with worsening of microcirculatory vessel condition, and of large arteries, prevalence of stenosing atherosclerosis of carotid arteries and CHD, that points on its properties of surrogate marker of endothelial dysfunction and further opportunities for its implementation with diagnostical aims.
About the Authors
A. Yu. GorshkovRussian Federation
N. G. Gumanova
Russian Federation
S. A. Boytsov
Russian Federation
References
1. Burduli NM, Aleksandrova OM. The role of endothelial dysfunction under development of microcirculatory disorders in patients with hypertension. Med Vestnik Severnogo Kavkaza 2007; 4: 22-6. Russian (Бурдули Н.М., Александрова О.М. Роль дисфункции эндотелия в развитии микроциркуляторных нарушений у больных гипертонической болезнью. Медицинский вестник Северного Кавказа 2007; 4: 22-6).
2. Davignon J, Ganz P. Role of endothelial dysfunction in atherosclerosis. Circulation 2004; 109: 27-32.
3. Serebrennikov RV. The role of endothelial dysfunction peripheral vascular in the process remodeling of the left chambers of the heart in patients with hypertension. Ultrasound and Functional Diagnostics 2007; 1: 60-6. Russian (Серебренников Р.В. Роль дисфункции эндотелия периферических сосудов в процессе ремоделирования левых камер сердца у больных артериальной гипертонией. Ультразвуковая и функциональная диагностика 2007; 1: 60-6).
4. Maksimenko AV, Turashev AD. Visualization, composition and structure of endothelial glycocalyx. The Journal of Atherosclerosis and Dyslipidemias 2011; 1: 28-34. Russian (Максименко А.В., Турашев А.Д. Визуализация, состав и структура эндотели- ального гликокаликса. Атеросклероз и дислипидемии 2011; 1: 28-34).
5. Vink H, Duling BR. Capillary endothelial surface layer selectively reduces plasma solute distribution volume. Am J Physiol Heart Circ Physiol 2000; 278(1): H285-9.
6. Jacob M, Rehm M, Loetsch M, et al. The endothelial glycocalyx prefers albumin for evoking shear stress-induced, nitric oxide-mediated coronary dilatation. J Vasc Res 2007; 44(6): 435-43.
7. Vink H, Duling BR. Identification of distinct luminal domains for macromolecules, erythrocytes, and leukocytes within mammalian capillaries. Circ Res 1996; 79(3): 581-9.
8. Maksimenko AV, Turashev AD. The functions and state of endothelial glycocalyx in the norm and pathology. The Journal of Atherosclerosis and Dyslipidemias 2011; 2: 4-17. Russian (Максименко А.В., Турашев А.Д. Функции и состояние эндотелиального гликокаликса в норме и патологии. Атеросклероз и дислипидемии 2011; 2: 4-17).
9. Lee DH, Dane MJ, van den Berg BM, et al. Deeper penetration of erythrocytes into the endothelial glycocalyx is associated with impaired microvascular perfusion. PloS One 2014; 9(5): e96477.
10. National guidelines for the diagnosis and treatment of stable angina. Cardiovascular Therapy and Prevention 2008; 7(6): Suppl 4. Russian (Национальные рекомендации по диагностике и лечению стабильной стенокардии. Кардиоваскулярная терапия и профилактика 2008; 7(6): Приложение 4).
11. Dane MJC, van den Berg BM, Avramut MC, et al. Glomerular Endothelial Surface Layer Acts as a Barrier against Albumin Filtration. Am J Pathology 2013; 182: 1532-40.
12. Noble MI, Drake-Holland AJ, Vink H. Hypothesis: arterial glycocalyx dysfunction is the first step in the atherothrombotic process. QJM 2008; 101: 513-8.
13. Vlahu СA, Lemkes BA, Struijk DG, et al. Damage of the Endothelial Glycocalyx in Dialysis Patients. J Am Soc Nephrol 2012; 23(11): 1900-8.
14. Mordvinova EV, Oschepkova EV, Fedorovich AA, et al. Arterial stiffness and functional state of skin microcirculatory vessels in the middle age persons with arterial hypertension. Regional Haemodynamics and Microcirculation 2014; 4: 18-27. Russian (Мордвинова Е.В., Ощепкова Е.В., Федорович А.А. и др. Жесткость сосудистой стенки и функциональное состояние сосудов микроциркуляторного русла кожи у лиц средней возрастной группы с артериальной гипертензией. Регионарное кровообращение и микроциркуляция 2014; 4: 18-27).
15. Lichtlen PR, Lippolt P, Rafilenbeui W, INTACT Group Investigators. Retardation of angiographic progression of coronary artery disease by nifedipine: the 6-year followup study of INTACT (International Nifedipine Trial on Antiatherosclerotic Therapy). J Cardiovasc Pharmacol 1996; 28 (Suppl.3): S10-21.
16. Brown MJ, Palmer CR, Castaigne A, et al. Morbidity and mortality in patients randomized to double-blind treatment with a long-acting calcium-channel blocker or diuretic in the International Nifedipine GETS study: Intervention as a Goal in Hypertension Treatment (INSIGHT). Lancet 2000; 356: 366-72.
17. Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low dose aspirin m patents with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 1998; 351: 1755-62.
Review
For citations:
Gorshkov A.Yu., Gumanova N.G., Boytsov S.A. Potential marker of endothelial dysfunction in patients with various grade of cardiovascular risk. Cardiovascular Therapy and Prevention. 2016;15(2):57-62. (In Russ.) https://doi.org/10.15829/1728-8800-2016-2-57-62