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Tesi etd-11152018-225113

Type of thesis
Corsi integrativi di I livello
Author
CHIRIACO', MARTINA
URN
etd-11152018-225113
Title
The importance of endothelial dysfunction in microvascular remodelling
Structure
Cl. Sc. Sperimentali - Medicina
Course
SCIENZE MEDICHE - Medicina e chirurgia (DM 270)
Committee
Membro ANGELONI, DEBORA
Presidente RECCHIA, FABIO ANASTASIO
Membro EMDIN, MICHELE
Membro PASSINO, CLAUDIO
Membro LIONETTI, VINCENZO
Membro Dott. MEOLA, MARIO
Membro Dott.ssa PETRUCCI, ILARIA
Relatore Prof. TADDEI, STEFANO
Membro Prof. COCEANI, FLAVIO
Keywords
  • cardiovascular risk
  • endothelial dysfunction
  • microcirculation
  • vascular remodelling
Exam session start date
;
Availability
parziale
Abstract
BACKGROUND: The relationship between cardiovascular risk factors (CVRFs), endothelial function, NO availability and vascular wall remodelling at the level of the microcirculation remains unknown. We sought to explore whether endothelial function and NO availability provide more information on the severity of microvascular remodelling than common CVRFs. We also explored whether the relationships of endothelial function and NO availability with parameters of microvascular remodelling differ in subjects at low or high cardiovascular risk. Finally, we assessed whether the patterns of microvascular remodelling associated with a deficit of NO availability are different than those related to CVRFs exposure.<br>METHODS: The microvascular dataset of the Italian Society for Arterial Hypertension (SIIA) was used for all analyses. This included 356 patients with information on media-to-lumen ratio (M/L), media cross-sectional area (MCSA), endothelial function, NO availability and levels of CVRF. The microvascular functional and structural information were acquired using pressure or wire myography. The European Heart Score was used to define the total cardiovascular risk of each patient.<br>RESULTS: Subjects with higher Heart Score had a greater M/L ratio and MCSA. Endothelial function was inversely related with the severity of microvascular remodelling, and this association remained significant even after adjustment for the Heart Score which, by contrast, lost its significant association with the M/L ratio and the MCSA in the same regression models. The strength of these associations was similar in subjects at high and low cardiovascular risk. Compared to the Heart Score alone, the addition of endothelial function and NO availability significantly improved the identification of subjects with more and less severe levels of microvascular remodelling. A greater deficit of NO availability was associated with hypertrophic remodelling, while in subjects with a higher Heart Score the pattern of vascular remodelling mainly presented eutrophic characteristics. <br>CONCLUSIONS: Microvascular endothelial function and NO availability might add important information on the severity of microvascular remodelling than the Heart Score, independently from the level of the patient cardiovascular risk.<br>
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