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    Coronary flow velocity reserve is reduced in patients with an exaggerated blood pressure response to exercise
    (Springer, 2022) Baycan, Ömer Faruk; Çelik, Fatma Betül; Güvenç, Tolga Sinan; Atıcı, Adem; Yılmaz, Yusuf; Konal, Oğuz; Ağırbaşlı, Mehmet; Kul, Şeref; Güllü, Hakan; Çalışkan, Mustafa
    Coronary artery disease and cardiovascular mortality are increased in patients with an exaggerated blood pressure response to exercise. The exact cause of this increase remains unknown, but previous studies have indicated the presence of endothelial dysfunction in peripheral arteries and subclinical atherosclerosis in these patients. The present study aimed to clarify whether coronary microvascular dysfunction is also present in patients with exaggerated blood pressure response to exercise. A total of 95 patients undergoing exercise testing were consecutively enrolled. Flow-mediated vasodilatation and carotid intima-media thickness were measured using standardized methods. A transthoracic echocardiography examination was performed to measure coronary flow velocity reserve. Patients with an exaggerated blood pressure response to exercise had significantly lower coronary flow velocity reserve than the controls (2.06 (1.91–2.36) vs. 2.27 (2.08–2.72), p = 0.004), and this difference was caused by a reduction in hyperemic flow velocity (57.5 (51.3–61.5) vs. 62.0 (56.0–73.0), p = 0.004) rather than a difference in basal flow (26.5 (22.3–29.8) vs. 26.0 (24.0–28.8), p = 0.95). Patients with an exaggerated blood pressure response to exercise also had a significantly greater carotid intima-media thickness and significantly lower flow-mediated vasodilatation than controls. However, an exaggerated blood pressure response to exercise remained a significant predictor of coronary microvascular dysfunction after adjusting for confounders (OR: 3.60, 95% CI: 1.23–10.54, p = 0.02). Patients with an exaggerated blood pressure response to exercise show signs of coronary microvascular dysfunction, in addition to endothelial dysfunction and subclinical atherosclerosis. This finding might explain the increased risk of coronary artery disease and cardiovascular mortality in these patients.
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    Coronary microvascular dysfunction is common in patients hospitalized with COVID-19 infection
    (Wiley, 2022) Atıcı, Adem; Çalışkan, Mustafa; Baycan, Ömer Faruk; Çelik, Fatma Betül; Güvenç, Tolga Sinan; Çağ, Yasemin; Konal, Oğuz; Bilgili, Ümmühan Zeynep; Ağırbaşlı, Mehmet Ali; Irgı, Tuğçe
    Background and Aims: Microvascular disease is considered as one of the main drivers of morbidity and mortality in severe COVID-19, and microvascular dysfunction has been demonstrated in the subcutaneous and sublingual tissues in COVID-19 patients. The presence of coronary microvascular dysfunction (CMD) has also been hypothe-sized, but direct evidence demonstrating CMD in COVID-19 patients is missing. In the present study, we aimed to investigate CMD in patients hospitalized with COVID-19, and to understand whether there is a relationship between biomarkers of myocardial injury, myocardial strain and inflammation and CMD.Methods:39 patients that were hospitalized with COVID-19 and 40 control subjects were included to the present study. Biomarkers for myocardial injury, myocardial strain, inflammation, and fibrin turnover were obtained at admission. A comprehen-sive echocardiographic examination, including measurement of coronary flow veloc -ity reserve (CFVR), was done after the patient was stabilized.Results:Patients with COVID-19 infection had a significantly lower hyperemic cor -onary flow velocity, resulting in a significantly lower CFVR (2.0 ± 0.3 vs. 2.4 ± 0.5, p< .001). Patients with severe COVID-19 had a lower CFVR compared to those with moderate COVID-19 (1.8 ± 0.2 vs. 2.2 ± 0.2, p< .001) driven by a trend toward higher basal flow velocity. CFVR correlated with troponin (p= .003, r: ?.470), B- type natriu-retic peptide (p< .001, r: ?.580), C- reactive protein (p< .001, r: ?.369), interleukin-6 (p< .001, r: ?.597), and d- dimer (p< .001, r: ?.561), with the three latter biomarkers having the highest areas-under- curve for predicting CMD.Conclusions:Coronary microvascular dysfunction is common in patients with COVID-19 and is related to the severity of the infection. CMD may also explain the “cryptic” myocardial injury seen in patients with severe COVID-19 infection.