Endothelial dysfunction, left ventricular diastolic dysfunction and the Systematic Coronary Risk Evaluation2 algorithm – a cross-sectional study

    Authors

    Keywords

    arginine analogs and derivatives, endothelium, diastole, risk assessment

    DOI

    https://doi.org/10.15836/ccar2022.256

    Full Text

    **Goal**: The goal of this study was to determine the relationship between the occurrence of left ventricular diastolic dysfunction (LVDD), the value of asymmetric dimethylarginine (ADMA) as a biomarker of endothelial dysfunction and estimated Systematic COronary Risk Evaluation2 algorithm (SCORE2). (1-3) **Patients and Methods:** A cross-sectional population study that included 178 adult people (79 women, 99 men) aged 40 to 65, was conducted in the period from November 15, 2019 to May 25, 2022. Sociodemographic, anthropometric characteristics and cardiovascular risk factors were recorded. Laboratory evaluation was performed. ADMA was determined by the ELISA method. Transthoracic echocardiography was used to assess left ventricular diastolic function. Chi-square test and Kruskal-Wallis test were used to evaluate the correlation between LVDD severity, SCORE2 value and plasma concentration of ADMA. Significance level p set at Alpha = 0.05. **Results**: Subjects with any degree of LVDD had a significantly higher SCORE2 compared to those with normal left ventricular diastolic function (p10 developed LVDD grade 2 and 3 (p< 0.001) and took medication significantly more often (p< 0.001). They also had significantly lower plasma ADMA values (p<0.001). Using Fisher’s exact test, we determined that angiotensin-converting enzyme inhibitors, beta-blockers, statins (p<0.001), mineralocorticoid receptor antagonists, aspirin (p=0.001), angiotensin receptor-neprilysin inhibitor (p=0.004), proton pump inhibitors (p=0.007), sodium-glucose transport protein 2 inhibitors, insulin and diuretics (p=0.01) had a favorable effect on lowering the concentration of ADMA in plasma. **Conclusion**: In our study we confirmed a positive correlation between LVDD and SCORE2 severity. Surprisingly, we obtained a negative correlation between biomarkers of endothelial dysfunction and severity of LVDD and SCORE2. We believe that the reason for this is the effect of drugs on endothelial dysfunction.

    Literature

    1. Zhou S, Zhu Q, Li X, Chen C, Liu J, Ye Y, et al. Asymmetric dimethylarginine and all-cause mortality: a systematic review and meta-analysis. Sci Rep. 2017 March 15;7:44692. https://doi.org/10.1038/srep44692
    2. Trocha M, Szuba A, Merwid-Lad A, Sozański T. Effect of selected drugs on plasma asymmetric dimethylarginine (ADMA) levels. Pharmazie. 2010 Aug;65(8):562-71. https://pubmed.ncbi.nlm.nih.gov/20824955/
    3. Zhao D, Guallar E, Vaidya D, Ndumele CE, Ouyang P, Post WS, et al. Cyclic Guanosine Monophosphate and Risk of Incident Heart Failure and Other Cardiovascular Events: the ARIC Study. J Am Heart Assoc. 2020 January 21;9(2):e013966. https://doi.org/10.1161/JAHA.119.013966
    Cardiologia Croatica
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    Endothelial dysfunction, left ventricular diastolic dysfunction and the Systematic Coronary Risk Evaluation2 algorithm – a cross-sectional study

    Extended Abstract
    Issue9-10
    Published
    Pages256
    PDF via DOIhttps://doi.org/10.15836/ccar2022.256
    arginine analogs and derivatives
    endothelium
    diastole
    risk assessment

    Authors

    Livija Sušić*ORCIDHealth Centre of Osijek-Baranja County, Osijek, Croatia
    Lana MaričićORCIDFaculty of Medicine, Osijek, Croatia
    Lucija KlobučarORCIDFaculty of Medicine, Osijek, Croatia
    Ines ŠahinovićORCIDFaculty of Medicine, Osijek, Croatia
    Kristina KralikORCIDFaculty of Medicine, Osijek, Croatia
    Tihomir SušićORCIDThe Information Institute Osijek, Osijek, Croatia
    Josip VinceljORCIDFaculty of Medicine, Osijek, Croatia

    *Correspondence email: livija.susic@gmail.com

    Full Text

    Goal: The goal of this study was to determine the relationship between the occurrence of left ventricular diastolic dysfunction (LVDD), the value of asymmetric dimethylarginine (ADMA) as a biomarker of endothelial dysfunction and estimated Systematic COronary Risk Evaluation2 algorithm (SCORE2). (1–3)

    Patients and Methods: A cross-sectional population study that included 178 adult people (79 women, 99 men) aged 40 to 65, was conducted in the period from November 15, 2019 to May 25, 2022. Sociodemographic, anthropometric characteristics and cardiovascular risk factors were recorded. Laboratory evaluation was performed. ADMA was determined by the ELISA method. Transthoracic echocardiography was used to assess left ventricular diastolic function. Chi-square test and Kruskal-Wallis test were used to evaluate the correlation between LVDD severity, SCORE2 value and plasma concentration of ADMA. Significance level p set at Alpha = 0.05.

    Results: Subjects with any degree of LVDD had a significantly higher SCORE2 compared to those with normal left ventricular diastolic function (p10 developed LVDD grade 2 and 3 (p< 0.001) and took medication significantly more often (p< 0.001). They also had significantly lower plasma ADMA values (p<0.001). Using Fisher’s exact test, we determined that angiotensin-converting enzyme inhibitors, beta-blockers, statins (p<0.001), mineralocorticoid receptor antagonists, aspirin (p=0.001), angiotensin receptor-neprilysin inhibitor (p=0.004), proton pump inhibitors (p=0.007), sodium-glucose transport protein 2 inhibitors, insulin and diuretics (p=0.01) had a favorable effect on lowering the concentration of ADMA in plasma.

    Conclusion: In our study we confirmed a positive correlation between LVDD and SCORE2 severity. Surprisingly, we obtained a negative correlation between biomarkers of endothelial dysfunction and severity of LVDD and SCORE2. We believe that the reason for this is the effect of drugs on endothelial dysfunction.

    Literature

    1. 1.
      Zhou S, Zhu Q, Li X, Chen C, Liu J, Ye Y, et al. Asymmetric dimethylarginine and all-cause mortality: a systematic review and meta-analysis. Sci Rep. 2017 March 15;7:44692.DOI
    2. 2.
      Trocha M, Szuba A, Merwid-Lad A, Sozański T. Effect of selected drugs on plasma asymmetric dimethylarginine (ADMA) levels. Pharmazie. 2010 Aug;65(8):562-71.PubMed
    3. 3.
      Zhao D, Guallar E, Vaidya D, Ndumele CE, Ouyang P, Post WS, et al. Cyclic Guanosine Monophosphate and Risk of Incident Heart Failure and Other Cardiovascular Events: the ARIC Study. J Am Heart Assoc. 2020 January 21;9(2):e013966.DOI