Endothelial function and left ventricular remodeling in diabetic and non-diabetic patients after acute coronary syndrome.
Endothelial function and left ventricular remodeling in diabetic and non-diabetic patients after acute coronary syndrome.
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DOI：
10.12659/msm.881390
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发表时间：
2011-02
期刊：
影响因子：
--
通讯作者：
Lubiński A
中科院分区：
文献类型：
--
作者：
Bissinger A;Grycewicz T;Grabowicz W;Lubiński A
内皮功能障碍是未来心脏事件的独立预测因子。我们评估了93例（70例男性，平均年龄：62±8岁）ACS患者接受直接血管成形术（PCI）治疗后肱动脉血流介导的扩张（FMD）与冠状动脉危险因素之间的关系。将患者分为2个亚组：43例2型糖尿病（DM）患者和50例非糖尿病（non-DM）患者。分别于ACS发生后第3天和6个月后进行检查。糖尿病患者第3天的FMD显著低于非糖尿病患者（5.8±2.2% vs. 8.8± 4.9%，p=0.0007），6个月后的FMD显著低于非糖尿病患者（6.2±2.6% vs. 9.4± 4.4%，p<0.0001）。还观察到，6个月随访后，两组FMD的改善与左心室舒张末期容积（LVEDV）的增加呈负相关（r=-0.41，p<0.001）。FMD与年龄（r=-0.26，p<0.01）、BMI（r=-0.26，p<0.005）、总胆固醇（r=-0.56，p<0.001）和LDL胆固醇（r=-0.53，p<0.001）呈负相关。甘油三酯、高血压和吸烟史之间无相关性。在DM组中，FMD与HbA 1c呈负相关（r=-0.68，p<0.001）。DM组再狭窄率显著较高（19% vs. 6%，p<0.001），但FMD与再狭窄之间无相关性。糖尿病患者FMD受损比非糖尿病ACS患者更显著。急性冠状动脉综合征后FMD缺乏改善可能是ACS患者左心室重构的预测因素。
Endothelial dysfunction is an independent predictor of future cardiac events. We evaluated the relationship between flow-mediated dilation (FMD) in brachial artery and coronary risk factors in 93 patients (70 males, mean age: 62±8 years) with ACS treated with primary angioplasty (PCI). The patients were divided into 2 subgroups: 43 patients with diabetes mellitus type 2 (DM) and 50 non-diabetics (non-DM). Patients were examined on the 3rd day after ACS and after 6 months. FMD on the 3rd day were significantly lower in DM than in non-DM (5.8±2.2% vs. 8.8±4.9%, p=0.0007) and after 6 months (6.2±2.6% vs. 9.4±4.4%, p<0.0001). It was also observed that the improvement of FMD in both groups after a 6-month follow-up inversely correlated with the increase of left ventricular end-diastolic volume (LVEDV) (r=−0.41, p<0.001). There was an inverse relationship between FMD and age (r=−0.26, p<0.01), BMI (r=−0.26, p<0,005), total cholesterol (r=−0.56, p<0.001) and LDL cholesterol (r=−0.53, p<0.001). There was no relationship between triglycerides, hypertension and history of smoking. In the DM group, FMD negatively correlated with HbA1c (r=−0.68, p<0.001). Restenosis rate was significantly higher in the DM group (19% vs. 6%, p<0.001) but there was no relationship between FMD and restenosis. Impaired FMD is more significant in diabetics than in non-diabetic patients with ACS. Lack of improvement of FMD after acute coronary syndrome can be a predictor of detrimental left ventricular remodeling in patients with ACS.
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