Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Dissertation committee:
Δέσποινα Περρέα, Ομότιμη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Δευτεραίος Σπυρίδων, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κόντζογλου Κωνσταντίνος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Τούτουζας Κωνσταντίνος του Παύλου, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αγγέλη Κωνσταντίνα, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Οικονομίδης Ιγνάτιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μακρυλάκης Κωνσταντίνος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Διερεύνηση των παραμέτρων της δοκιμασίας κοπώσεως σε νέους ενήλικες άντρες με ετερόζυγο οικογενή υπερχολεστερολαιμία (hFH)
Translated title:
Investigation of exercise treadmill test parameters in young adult men with heterozygous familial hypercholesterolaemia (hFH)
Summary:
Familiar hypercholesterolemia (FH) is mainly due to mutations of the gene coding the LDL-receptor. The lipidemic profile of such patients is characterized by elevated levels of both total (TC), and LDL cholesterol. Elevated triglyceride (TG) and low HDL levels might also coexist. The most important consequence is the increased prevalence of early and accelerated atherosclerotic disease, particularly in the homozygotes, who develop coronary artery disease (CAD) before the age of 10. Nowadays, the management of FH includes a spectre of hypolipidemic drugs, aiming to the inhibition of the hepatic production or prevention of the intestinal absorption of cholesterol. The non pharmacological therapy includes LDL-apheresis, a procedure being able to directly remove LDL cholesterol from circulation with beneficial results mainly in homozygotes and severe eterozygotes as well. Monoclonal antibodies that inhibit PCSK9 are a new class of drugs that lower LDL cholesterol in patients that can not tolerate hypolipidemic drugs or when the LDL cholesterol reduction could not been achieved.Exercise treadmill testing (ETT) is a well-established, easy, safe and low-cost procedure, used for many decades as a noninvasive test to diagnose CAD. The normal response of the blood pressure in progressive exercise testing is the systolic blood pressure (SBP) to increase, while the diastolic blood pressure (DBP) to be maintained or to decrease slightly. Furthermore, the visual assessment of two-dimensional (2D) echocardiography provides a rapid evaluation of left ventricle (LV) systolic function. A more thorough evaluation of LV systolic function requires calculation of LV ejection fraction (LVEF) using Simpson's biplane method. Novel echocardiographic techniques allow the assessment of myocardial strain, which can measure myocardial deformation as an intrinsic mechanical property of the myocardium. In our study, we evaluated the change of the SBP and DBP during the ETT in asymptomatic adult heFH men without known CAD and with normal LVEF. Furthermore, we combined it with probable early detection of myocardial systolic abnormality assessed by measuring GLS. We found that heFH men showed a higher peak SBP and DBP at ETT and higher corresponding delta values, compared with healthy men. A slight but statistically significant reduction of GLS was also documented, although no difference in LVEF was identified. These findings lead to the assumption of preclinical cardiovascular impairment presence in a heFH male population.
Main subject category:
Health Sciences
Keywords:
Familiar hypercholesterolemia, Exercise treadmill test, Color Doppler echocardiography
Number of references:
186
