Endothelial function assessment: flow-mediated dilation and constriction provide different and complementary information on the presence of coronary artery disease
Endothelial function assessment: flow-mediated dilation and constriction provide different and complementary information on the presence of coronary artery disease
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DOI：
10.1093/eurheartj/ehr361
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发表时间：
2012-02-01
影响因子：
39.3
通讯作者：
Muenzel, Thomas
中科院分区：
文献类型：
--
作者：
Gori, Tommaso;Muxel, Selina;Muenzel, Thomas
目的动脉粥样硬化的危险因素已经被识别，但仍然很难预测这些因素在决定冠状动脉疾病(CAD)的发展中如何相互作用。血管内皮细胞功能的研究是否提供了传统危险因素之外的信息也尚不清楚。方法和结果连续4 5 1例患者在冠状动脉造影术前测量了血流介导的扩张和低血流介导的收缩(L-FMC)。低血流介导的收缩(P<；0.0001)和FMD(P=0.0005)随病变血管数目的增加而递减，且L-FMC与句法评分呈显著线性相关(R=0.38；P<；0.0001)。Logistic回归分析证实血管内皮功能参数与冠心病相关(P=0.001.0 5，P=0.0 2)。受试者操作特征分析显示，L-fmc单独加入以及fmd和L-fmc联合使用提高了传统危险因素模型对冠心病的预测能力(风险因素模型曲线下面积=0.716；风险因素模型+fmd=0.734，P=0.10；风险因素模型+L-fmc=0.771，P=0.004；危险因素模型+L-fmc+fmd=0.779，P=0.002)。再分类统计显示，在传统危险因素的基础上引入口蹄疫模型后，正确再分类的患者增加了5%，而引入L-FMC网的患者正确再分类的比例为19%。不同的内皮功能参数之间没有相关性。结论内皮功能评估在预测冠心病的存在方面提供了适度但有统计学意义的补充信息。
Aims A number of risk factors for atherosclerosis have been identified, but it remains difficult, on an individual patient basis, to predict how these factors interact in determining the development of coronary artery disease (CAD). It also remains unclear whether the study of endothelial function provides information that is additive to that of traditional risk factors.Methods and results Flow-mediated dilation (FMD) and low-flow-mediated constriction (L-FMC) were measured in 451 consecutive patients before coronary angiography. Low-flow-mediated constriction (P < 0.0001) and FMD (P = 0.0005) progressively decreased with the number of diseased vessels, and L-FMC showed a significant linear correlation with the SYNTAX score (R = 0.38; P < 0.0001). Logistic regression analysis confirmed the association between endothelial function parameters and CAD (P = 0.001 for L-FMC, P = 0.02 for FMD). Receiver operating characteristic analysis demonstrated that the addition of L-FMC alone and of the combination of FMD and L-FMC improved the predictive power of a model based on traditional risk factors for CAD (area under the curve of the risk factor model = 0.716; risk factor model + FMD = 0.734, P = 0.1 compared with risk factor model; risk factor model + L-FMC = 0.771, P = 0.004; risk factor model + L-FMC + FMD = 0.779, P = 0.002). Reclassification statistics showed that the introduction of FMD to the model based on the traditional risk factors correctly reclassified an additional 5% of patients, and that the introduction of L-FMC net correctly reclassified 19% of the patients. There was no correlation between different parameters of endothelial function.Conclusion Endothelial function assessment provides modest but statistically significant additional information in predicting the presence of CAD.