Kiểm soát đau thắt ngực và nguy cơ tim mạch thông qua cải thiện chức năng nội mạc

15th National Congress of Cardiology Hanoi, Vietnam, October 9-11, 2016 Managing Angina and Risk via Improved Endothelial Function Gregory W Barsness, MD, FACC, FAHA, FSCAI Consultant, Internal Medicine & Cardiology and Radiology Director, Mayo Clinic EECP Laboratory Director, Mayo Clinic Cardiac Intensive Care Unit Mayo Clinic College of Medicine Rochester, MN, USA Nothing to Disclose Related to this Talk Cardiovascular Diseases Epidemiology and Economics  Leading global cause of death:  17.3 m/yr, increasing to >23 million by 2030  20-30% of global deaths (including US)  Most costly disease in US (> $320 b/yr)  Affects >85 million in US  Costs will double by 2030 Ischemic Heart Disease in Vietnam Growing and Costly Problem In 2011: 38% of Deaths related to CV Disease 23% of Deaths from Stroke 15% of Death attributable to Coronary Disease By 2017: 20% prevalence of CV Disease and HTN WHO Report 2011 Data from 2016 Pacific Cross Vietnam (Blue Cross Vietnam) Patient Vulnerability to ACS Smoking Hypertension Hypercholesterolemia New risk factors Diabetes Genomic predisposition Endothelial Dysfunction ► The Vulnerable Patient Dementia Heart failure Bonetti et al, ATVB 2003 Stroke Acute Coronary syndrome Sudden death Naghavi et al, Circulation 2003 The Endothelium The Ideal Diagnostic and Therapeutic Target The endothelium is the largest organ in the body Importance of Shear Stress CTO Revascularization and Mo FollowUp Shear Stress is Atheroprotective • Anti-thrombotic • Anti-proliferative • Pro-Survival Shear Stress is Vasodilatory Month Follow Up Endothelial Function The Importance of Balance Normal Endothelial Function NO ET-1 PGI2 AngII Vasodilation Atheroprotective Endothelial Function The Importance of Balance Endothelial Dysfunction NO PGI2 ET-1 AngII ↓Endothelial repair Depletion of EPCs Vasoconstriction Atherogenic Normal Acetylcholine Response Acetylcholine M3 Intact Endothelium Vascular smooth muscle NO Soluble guanylate cyclase Relaxation GTP cGMP Abnormal Acetylcholine Response Acetylcholine M3 Impaired Endothelium NO M3 Vascular smooth muscle G proteins + PKC PIP2  IP3 + DAG CA2+ Contraction Coronary Endothelial Dysfunction Relationship to Ischemia 350 300 Coronary blood flow response (%) NS Exercise thallium Normal Abnormal 250 400 300 P