title: Systemic inflammation is related to coronary microvascular dysfunction in obese patients without obstructive coronary disease.
abstract: OBJECTIVE
  Obesity, systemic inflammation and changes in the heart functions are associated with increased cardiovascular risk. This study aimed to investigate coronary microvascular dysfunction as an early marker of atherosclerosis in obese patients without any evidence of cardiovascular disease.
  
  
  RESULTS
  86 obese subjects (aged 44 ± 12 years, body mass index (BMI) 41 ± 8 kg m(-2)), without evidence of heart disease, and 48 lean controls were studied using transthoracic Doppler echocardiography for detecting coronary flow reserve (CFR). A value of CFR ≤ 2.5 was considered abnormal. We measured interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α) and adiponectin in all patients. Patients with abnormal CFR underwent coronary multislice computed tomography (MSCT) in order to exclude an epicardial stenosis. CFR in obese subjects was lower than in lean subjects (3.2 ± 0.8 vs. 3.7 ± 0.7, p = 0.02) and was abnormal in 27 (31%) obese patients and in one (2%) control (p < 0.0001). All subjects with abnormal CFR showed no coronary stenosis at MSCT. At multivariable analysis, IL-6 and TNF-α were the only determinants of CFR (p < 0.02 and p < 0.02, respectively). At multivariable logistic regression analysis, IL-6 and TNF-α were the only determinants of CFR ≤ 2.5 (p < 0.03 and p < 0.03, respectively).
  
  
  CONCLUSIONS
  CFR is often reduced in obese subjects without clinical evidence of heart disease, suggesting a coronary microvascular impairment. This microvascular dysfunction seems to be related to a chronic inflammation mediated by adipocytokines. Our findings may explain the increased cardiovascular risk in obesity, independently of BMI.
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, University of Cagliari, Cagliari, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Tona
authors.affiliation: Internal Medicine 3, Center for the Study and Integrated Treatment of the Obesity, Bariatric Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Serra
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, University of Cagliari, Cagliari, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Di Ascenzo
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, University of Cagliari, Cagliari, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Osto
authors.affiliation: Internal Medicine 3, Center for the Study and Integrated Treatment of the Obesity, Bariatric Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Scarda
authors.affiliation: Internal Medicine 3, Center for the Study and Integrated Treatment of the Obesity, Bariatric Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Fabris
authors.affiliation: Department of Cardiological and Neurological Sciences, University of Cagliari, Cagliari, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Montisci
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, University of Cagliari, Cagliari, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Famoso
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, University of Cagliari, Cagliari, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Tellatin
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, 1st Surgical Clinic, University of Padua, Padua, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Foletto
authors.affiliation: Department of Radiology, Abano Terme Hospital, Padua, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Giovagnoni
authors.affiliation: Department of Cardiologic, Thoracic and Vascular Sciences, University of Cagliari, Cagliari, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Iliceto
authors.affiliation: Internal Medicine 3, Center for the Study and Integrated Treatment of the Obesity, Bariatric Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy. Electronic address: roberto.vettor@unipd.it.
authors.forename: R
authors.initials: R
authors.lastname: Vettor
mesh_terms: D052242:Adiponectin / Q000097:blood; D000328:Adult; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016015:Logistic Models; D008297:Male; D008833:Microcirculation; D055806:Microvessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D009765:Obesity / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin; D015415:Biomarkers; C508600:IL6 protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha
keywords: Coronary flow reserve; Inflammation; Microvascular dysfunction; Obesity; Prevention