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Lipid sub-fractionation predicts worsening myocardial perfusion reserve in patients with low-density lipoprotein less than 100mg/dL: a regadenoson dardiac magnetic resonance study

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Journal of Cardiovascular Magnetic Resonance201214 (Suppl 1) :P70

https://doi.org/10.1186/1532-429X-14-S1-P70

  • Published:

Keywords

  • Myocardial Perfusion Imaging
  • Particle Concentration
  • Regadenoson
  • Microvascular Dysfunction
  • Myocardial Perfusion Reserve

Summary

We sought to determine, in patients with LDL <100mg/dL, if abnormalities in lipid sub-fractionation are associated with reduced myocardial perfusion reserve (MPRi; a surrogate for microvascular dysfunction). Despite the absence of a correlation between low-density lipoprotein and MPRi, a significant inverse relationship between sub-fractions of LDL and MPRi exists.

Background

Abnormalities in total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides (TG) are associated with microvascular dysfunction and are the primary target for treating atherosclerosis. Newer lipid assays allow for measurements of lipoprotein sub-fractions; however, their impact on microvascular function remain unknown. We sought to determine, in patients with LDL <100mg/dL, if abnormalities in lipid sub-fractionation are associated with reduced myocardial perfusion reserve (MPRi; a surrogate for microvascular dysfunction).

Methods

Ninteen patients with an LDL <100mg/dL underwent regadenoson cardiac magnetic resonance myocardial perfusion imaging (CMR-MPI) and had a nuclear magnetic resonance (NMR) lipid panel (Mayo Clinic; Rochester, MN) drawn. Imaging was performed using a 1.5T MRI scanner. Short-axis images were obtained at three levels of the left ventricle (LV) during first pass of a Gadolinium-DTPA bolus (0.075 mmol/kg at 4 ml/sec) for approximately 50 consecutive heart beats. Images were acquired using a hybrid gradient echo/echo planar imaging sequence 1 minute after injection regadenoson and then repeated 15 minutes after injection of aminophylline 125mg. Time intensity curves were generated to determine the area under-the-curve (from the start of the upslope to the peak of the upslope) for the mid-ventricular slice and the LV cavity. MPRi was defined as the stress-to-rest ratio of mid-ventricular area under-the-curve (normalized to LV cavity area under-the-curve). NMR lipid panels yielded the traditional cholesterol profile plus total-LDL particle concentration (nmol/L), small-LDL particle concentration (nmol/L), total-HDL particle concentration (μmol/L), and large-HDL particle concentration (μmol/L). Linear regression was performed to determine the relationship between traditional lipid profile, lipid fractions and MPRi.

Results

Most patients were male (86%). Their age was 50.4±14.5 years, 53% had coronary disease, 42% had hypertension, and 11% were current smokers. No relationship was found between MPRi and total cholesterol, LDL, total-HDL particle concentration, and large-HDL particle concentration. However, MPRi was significantly correlated to HDL and inversely correlated to triglycerides, small-LDL particle concentration and total-LDL concentration (R-squared= 0.35, 0.25, 0.28, and 0.26 (p-value= 0.004, 0.02, 0.03 and 0.02), respectively). See Figure 1.
Figure 1
Figure 1

Relationship between myocardial perfusion reserve index and various lipid abnormalities.

Conclusions

Despite the absence of a correlation between LDL with MPRi in patients with an LDL <100mg/dL, an inverse relationship between sub-fractions of LDL (namely small LDL concentration and total LDL concentration) and MPRi existed suggesting that lipid subfractionation could identify patients with LDL <100mg/dL who might have microvascular dysfunction.

Funding

This study was funded by Astellas.

Authors’ Affiliations

(1)
Medicine, University of Chicago, Chicago, IL, USA
(2)
Mahidol University, Bangkok, Thailand
(3)
University of Bologna, Bologna, Italy
(4)
Loyola Medical Center, Maywood, IL, USA

Copyright

© Narang et al; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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