Is the presence of AA amyloidosis associated with impaired coronary flow reserve?
Systemic amyloid A protein (AA) amyloidosis may occur as a complication of many chronic inflammatory disorders. Patients receiving inadequate anti-inflammatory and immunosuppressive therapies have an increased risk of developing systemic AA amyloidosis. Inflammation plays a role in all stages and the thrombotic complications of atherosclerosis. In the absence of epicardial coronary stenosis, coronary flow reserve (CFR) reflects coronary microvascular dysfunction. In the present study, we hypothesized that amyloid advanced subclinical inflammation in chronic inflammatory diseases (CID) patients may further affect coronary microcirculation.



Thirty-two patients with biopsy-diagnosed renal AA, 73 patients with non-amyloid CID, and a group of healthy volunteers were included in the study. The measurements of coronary flow velocity were performed by a single investigator with expertise in transthoracic Doppler harmonic echocardiography (TTDE).



The AA amyloidosis subgroup had significantly lower CFR values than other non-amyloid CID patients and the control individuals (1.8 (1.5-2.1) vs. 2.1 (2.0-2.4) and 3.0 (2.8-3.2), p < 0.001). Multivariate logistic regression analysis indicated that the presence of AA amyloidosis and elevated hs - CRP independently predict impairment of the CFR (p < 0.05).



The presence of AA amyloidosis is related to decreased CFR values and the presence of AA amyloidosis and elevated hs - CRP independently predict impairment of the CFR. Therefore, patients with AA amyloidosis may have an increased risk of developing coronary artery diseases.
Istanbul Kartal KosuyoluYuksek Ihtisas Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
Mustafa
M
Bulut
Istanbul Medeniyet University, Goztepe Training and Research Hospital, Department of Cardiology, Istanbul, Turkey. Electronic address: drnursenkeles@yahoo.com.tr.
Nursen
N
Keles
Istanbul Umraniye Training and Research Hospital, Department of Gastroenterology, Istanbul, Turkey.
Zuhal
Z
Caliskan
Istanbul Medeniyet University, Goztepe Training and Research Hospital, Department of Internal Medicine, Turkey.
Osman
O
Kostek
Istanbul Medeniyet University, Goztepe Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
Feyza
F
Aksu
Istanbul Umraniye Training and Research Hospital, Department of Gastroenterology, Istanbul, Turkey.
Kamil
K
Ozdil
Istanbul Kartal KosuyoluYuksek Ihtisas Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
Mustafa
M
Akcakoyun
Istanbul Medeniyet University, Goztepe Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
Kenan
K
Demircioglu
Istanbul Medeniyet University, Goztepe Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
Yusuf
Y
Yilmaz
Koc University School of Medicine, Department of Medicine, Division of Nephrology, Istanbul, Turkey.
Mehmet
M
Kanbay
Istanbul Medeniyet University, Goztepe Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
Mustafa
M
Caliskan
D000328:Adult; D000686:Amyloidosis / Q000503:physiopathology*; D050197:Atherosclerosis; D001783:Blood Flow Velocity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis*; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000503:physiopathology*; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012307:Risk Factors; D012737:Sex Factors; D018608:Ultrasonography, Doppler; D018487:Ventricular Dysfunction, Left; D016277:Ventricular Function, Left
AA amyloidosis; Atherosclerosis; Coronary flow reserve