title: Effects of Insulin Resistance on Myocardial Blood Flow and Arterial Peripheral Circulation in Patients with Polycystic Ovary Syndrome.
abstract: OBJECTIVE
  Polycystic ovary syndrome (PCOS) is associated with increased risk for cardiovascular disease. We sought to evaluate the effects of insulin resistance (IR) on myocardial microcirculation and peripheral artery function in patients with PCOS.
  
  
  METHODS
  We studied 55 women (28 with PCOS without IR, 18 with PCOS and IR and 11 normal controls) who underwent laboratorial analysis, high-resolution vascular ultrasound and real time myocardial contrast echocardiography (RTMCE). Intima-media thickness (IMT) and brachial artery flow-mediated dilation (FMD) were evaluated by vascular ultrasound. The replenishment velocity (β), plateau of acoustic intensity (A) and myocardial blood flow reserve (MBFR) were determined by quantitative dipyridamole stress RTMCE.
  
  
  RESULTS
  β reserve in group PCOS + IR was lower than control (2.34 ± 0.55 vs. 3.60 ± 0.6; P < 0.001) and than PCOS without IR (2.34 ± 0.55 vs. 3.17 ± 0.65; P < 0.001). MBFR in patients with PCOS without IR did not differ from those of control (4.59 ± 1.59 vs. 5.30 ± 1.64; P = 0.22) or from patients with PCOS + IR (4.59 ± 1.59 vs. 3.70 ± 1.47; P = 0.07). When comparing with control group, patients with PCOS + IR had lower MBFR (5.30 ± 1.64 vs. 3.70 ± 1.47; P = 0.01). No significant differences were found between control, PCOS without IR and PCOS + IR for FMD (0.18 ± 0.05, 0.15 ± 0.04 and 0.13 ± 0.07; P =NS) or IMT (0.48 ± 0.05, 0.47 ± 0.05 and 0.49 ± 0.07; P = NS).
  
  
  CONCLUSIONS
  Women with PCOS and IR had depressed β and MBFR as demonstrated by quantitative RTMCE, but no alteration in endothelial dysfunction or IMT. PCOS without IR showed isolated depression in β reserve, probably an earlier marker of myocardial flow abnormality.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medical Sciences of Santa Casa, São Paulo, Brazil.
authors.forename: José M
authors.initials: JM
authors.lastname: Aldrighi
authors.affiliation: Heart Institute (InCor), University of Sao Paulo Medical School and Fleury Group, São Paulo, Brazil.
authors.forename: Jeane M
authors.initials: JM
authors.lastname: Tsutsui
authors.affiliation: Heart Institute (InCor), University of Sao Paulo Medical School and Fleury Group, São Paulo, Brazil.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Kowastch
authors.affiliation: Department of Obstetrics and Gynecology, School of Medical Sciences of Santa Casa, São Paulo, Brazil.
authors.forename: Alessandra L
authors.initials: AL
authors.lastname: Ribeiro
authors.affiliation: Department of Obstetrics and Gynecology, School of Medical Sciences of Santa Casa, São Paulo, Brazil.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Scapinelli
authors.affiliation: Department of Obstetrics and Gynecology, School of Medical Sciences of Santa Casa, São Paulo, Brazil.
authors.forename: Sonia
authors.initials: S
authors.lastname: Tamanaha
authors.affiliation: Department of Obstetrics and Gynecology, School of Medical Sciences of Santa Casa, São Paulo, Brazil.
authors.forename: Ricardo M
authors.initials: RM
authors.lastname: Oliveira
authors.affiliation: Heart Institute (InCor), University of Sao Paulo Medical School and Fleury Group, São Paulo, Brazil.
authors.forename: Wilson
authors.initials: W
authors.lastname: Mathias
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003326:Coronary Circulation; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D011085:Polycystic Ovary Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography
keywords: contrast echocardiography; coronary flow reserve; insulin resistance; polycystic ovary syndrome