Prolongation of PR interval is associated with endothelial dysfunction and activation of vascular repair in high-risk cardiovascular patients
Prolongation of PR interval is associated with endothelial dysfunction and activation of vascular repair in high-risk cardiovascular patients
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DOI：
10.1007/s10840-012-9777-z
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发表时间：
2013-06-01
影响因子：
1.8
通讯作者：
Tse, Hung-Fat
中科院分区：
文献类型：
--
作者：
Chan, Yap-Hang;Siu, Chung-Wah;Tse, Hung-Fat
流行病学研究表明，PR延长与心血管不良结局的风险增加有关。我们研究了PR间期与血管功能和内皮修复指标之间的关系作为潜在的机制。这项研究包括348名既往有冠状动脉疾病、缺血性中风和/或糖尿病的高危患者和150名无此病史的健康受试者。静息12导联心电图示PR间期延长，如200毫秒。血管功能评价采用高分辨率超声臂部血流监测技术(FMD)。在健康人中，PR间期与FMD呈负相关(R=-0.2，P=0.015)，而与CD133(+)/KDR+内皮祖细胞水平无关(R=0.05，P=0.58)。在高危心血管病患者中，PR延长和GT；200ms较健康受试者更为常见(45/348(13%)比4/150(3%)，P<；0.001)。PR间期与FMD呈负相关(R=-0.14，P=0.009)，与CD133(+)/KDR+EPC呈正相关(R=+0.14，P=0.05)。PR延长患者外周血CD133(+)/KdR+EPC水平明显升高(P=0.005)。校正潜在混杂因素后，PR间期延长仍与CD133(+)/KDR+EPC增加+0.002(95%可信区间0.000至0.004(对数，x10(-3)/ml，P=0.011)和降低的FMD(B=-0.014%，95%CI-0.027至-0.002，P=0.026)独立相关。PR延长与心血管高危患者的内皮功能障碍和内皮修复激活有关。
Epidemiological studies showed that PR prolongation is associated with increased risk of adverse cardiovascular outcomes. We investigated the relations of PR interval with indices of vascular function and endothelial repair as the underlying mechanisms.The study comprised 348 high-risk patients with prior coronary artery disease, ischemic stroke, and/or diabetes mellitus recruited from medical outpatient clinics and 150 healthy subjects without such a history. PR interval was considered prolonged if > 200 ms, as determined from resting 12-lead electrocardiogram. Vascular function was assessed by brachial flow-meditated dilatation (FMD) using high-resolution ultrasound. Circulating CD133(+)/KDR+ endothelial progenitor cell (EPC) levels were measured by flow cytometry.Among healthy subjects, PR interval was inversely associated with FMD (R = -0.20, P = 0.015), but not with the level of circulating CD133(+)/KDR+ EPC (R = 0.05, P = 0.58). Among high-risk cardiovascular patients, PR prolongation > 200 ms was more common compared with healthy subjects (45/348 (13 %) versus 4/150 (3 %), P < 0.001). PR interval was associated inversely with FMD (R = -0.14, P = 0.01) and positively with circulating CD133(+)/KDR+ EPC level (R = +0.14, P = 0.009). Circulating CD133(+)/KDR+ EPC level was significantly increased in patients with PR prolongation > 200 ms (0.87 +/- 0.37 versus 0.68 +/- 0.42 (log, x10(-3)/ml), P = 0.005). Adjusted for potential confounders, increased PR interval remained independently associated with increased CD133(+)/KDR+ EPC by +0.002 (95 % confidence interval (CI) 0.000 to 0.004 (log, x10(-3)/ml), P = 0.011) and depressed FMD (B = -0.014 %, 95 % CI -0.027 to -0.002, P = 0.026).PR prolongation is associated with endothelial dysfunction and evidence of endothelial repair activation in patients with high cardiovascular risk.