Istituto di Fisiologia Clinica     
Neglia D., Sampietro T., Vecoli C., Liga R., Rossi G., Filidei E., Bigazzi F., Iozzo P., Giannessi D., L'Abbate A., Rovai D. Low High-Density Lipoprotein Cholesterol and Abnormal Glucose Control in Idiopathic Left Ventricular Dysfunction. In: Circulation, vol. 124 p. -. American Heart Association, 2011.
Aims: To investigate whether cardiovascular (CV) risk factors are associated with myocardial blood flow (MBF) abnormalities and play any prognostic role in patients with idiopathic left ventricular (LV) dysfunction. Methods: We studied 83 patients (61 males, age 6010 years) with mild-to-severe LV dysfunction (mean ejection fraction 38%, range 19-53%), no history of diabetes and angiographically normal coronary arteries. We measured absolute MBF by positron emission tomography and 13N-ammonia at rest and after dipyridamole. The following CV risk factors were recorded: age, sex, family history of coronary artery disease or dilated cardiomyopathy, newly diagnosed type II diabetes (NIDD), insulin resistance (IR, defined as Homeostasis Model Assessment index >2), hypertension, hypercholesterolemia, low high density lipoprotein (HDL) cholesterol, smoking habit, and obesity. Cardiac death, transplantation, and progressive LV dysfunction were the censored events during followup. Results: Depressed MBF reserve (<2) was present in 48 patients (58%). Using multivariate logistic regression analysis, low HDL cholesterol (P = 0.039) and NIDD or IR (P = 0.012) were the only variables significantly associated with depressed MBF during stress after adjustment for risk factors, LV function and pharmacological treatment. Moreover, low HDL cholesterol (P = 0.039) and female sex (P = 0.021) were significantly associated with depressed MBF reserve. During follow-up (median, 6 years), cardiac events occurred in 18 patients (22%). At Cox regression analysis, depressed MBF reserve (P = 0.034) and LV dilatation (P = 0.047) were the only significant and independent predictors of event-free survival. Conclusion: In idiopathic LV dysfunction, low HDL cholesterol and NIDD/IR are associated with abnormal hyperemic MBF and flow reserve. Risk factors are not determinants of patient outcome, which is predicted by MBF reserve and LV dilatation.
Subject Positron emission tomography Cardiomyopathy Risk factors HDL Insulin resistance

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