Simultaneous Noninvasive Assessment of Systemic and Coronary Endothelial Function.
Simultaneous Noninvasive Assessment of Systemic and Coronary Endothelial Function.
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DOI：
10.1161/circimaging.115.003954
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发表时间：
2016-03
期刊：
影响因子：
--
通讯作者：
Weiss RG
中科院分区：
文献类型：
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作者：
Iantorno M;Hays AG;Schär M;Krishnaswamy R;Soleimanifard S;Steinberg A;Stuber M;Gerstenblith G;Weiss RG
正常的内皮功能是血管健康和功能障碍的一个指标，是冠状动脉事件的预测因子。一氧化氮（NO）介导的冠状动脉内皮功能（CEF），在等长握力运动（IHE）过程中血管反应性评估，最近量化与MRI无创。由于内乳动脉（IMA）经常在冠状动脉MRI可视化，我们提出的战略，同时评估全身和冠状动脉内皮功能的MRI无创IHE。应用3 T MRI对25例冠心病患者和26例健康对照者的右冠状动脉（RCA）和IMA的横截面积（CSA）和血流量（BF）进行检测。在8名健康受试者中，输注NO合酶抑制剂以评估NO在IMA-IHE反应中的作用。CSA（R=0.91）和BF（R= 0.91）的观察者间IMA-IHE重现性良好。在健康受试者中，IMA的CSA和BF在IHE期间增加，并且这些反应被L-NMMA显著减弱（与安慰剂相比p<0.01）。在CAD患者中，IHE未使RCA扩张，IMA扩张小于健康受试者（p=0.01）。CAD患者的RCA和IMA对IHE的BF反应也显著降低。MRI检测的IMA对IHE的反应主要反映NO依赖性内皮功能，在CAD患者中是可重复的和减少的。冠状动脉和全身（IMA）动脉的内皮功能现在可以用相同的成像技术进行无创测量，并有望对影响血管健康的全身和局部因素有新的见解。
Normal endothelial function is a measure of vascular health and dysfunction a predictor of coronary events. Nitric Oxide (NO)-mediated coronary artery endothelial function (CEF), as assessed by vasomotor reactivity during isometric handgrip exercise (IHE), was recently quantified noninvasively with MRI. Because the internal mammary artery (IMA) is often visualized during coronary MRI we propose the strategy of simultaneously assessing systemic and coronary endothelial function noninvasively by MRI during IHE. Changes in cross-sectional area (CSA) and blood flow (BF) in the right coronary artery (RCA) and the IMA in 25 CAD patients and 26 healthy subjects during IHE were assessed using 3T MRI. In 8 healthy subjects a NO synthase inhibitor was infused to evaluate the role of NO in the IMA-IHE response. Inter-observer IMA-IHE reproducibility was good for CSA (R=0.91) and BF (R=0.91). In healthy subjects, CSA and BF of the IMA increased during IHE and these responses were significantly attenuated by L-NMMA (p<0.01 vs. placebo). In CAD patients, the RCA did not dilate with IHE and dilation of the IMA was less than that of the healthy subjects (p=0.01). The BF responses of both the RCA and IMA to IHE were also significantly reduced in CAD patients. MRI-detected IMA responses to IHE primarily reflect NO-dependent endothelial function, are reproducible and reduced in CAD patients. Endothelial function in both coronary and systemic (IMA) arteries can now be measured noninvasively with the same imaging technique and promises novel insights into systemic and local factors affecting vascular health.