The prognostic importance of endothelial dysfunction and carotid atheroma burden in patients with coronary artery disease
The prognostic importance of endothelial dysfunction and carotid atheroma burden in patients with coronary artery disease
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DOI：
10.1016/s0735-1097(03)00927-6
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发表时间：
2003-09-17
影响因子：
24
通讯作者：
Ignaszewski, A
中科院分区：
文献类型：
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作者：
Chan, SY;Mancini, GBJ;Ignaszewski, A
目的探讨无创检测血管内皮功能和动脉粥样硬化负荷对冠心病患者预后的相对重要性。背景：颈动脉超声直接检测动脉粥样硬化和肱动脉血流介导的扩张术(FMD)评估内皮功能均可预测血管事件。颈动脉超声和FMD相对于传统危险标记物和心血管健康状况的联合预后作用尚未得到评估。方法共152例冠心病患者接受了代谢试验、运动负荷试验、颈动脉超声和内皮功能测定。结果对患者进行了34+/-10个月的随访，在此期间发生了22起血管事件。在有事件的受试者中，FMD峰值(P=0.012)和FMD/硝酸甘油介导的扩张(NMD)比率(P=0.008)较低。采用COX比例风险模型的单变量分析确定斑块面积(p=0.0047)、总面积(p=0.0085)、峰值功能密度(p=0.01)、功能/功能密度比(p=0.008)、负荷试验工作量(p=0.027)、长效硝酸甘油(p=0.0071)和钙拮抗剂(p=0.0057)是不良事件的预测因素。多因素分析显示，FMD/NMD比值(p<；0.0001)、颈动脉斑块面积(p=0.06)和NTG(p=0.005)是独立的预测因素。根据中位数，受试者被分为高和低“斑块负荷”组以及高和低FMD/NMD亚组。无论颈动脉粥样硬化的程度如何，FMD/NMD高的患者的事件发生率都较低。低FMD/NMD和高“斑块负荷”患者的事件发生率最高(P<；0.05)。结论血管结构和功能状态是冠心病患者发生冠状动脉事件的独立预测因素，无创性测量血管内皮功能和颈动脉粥样硬化负荷。保存的内皮功能可降低与高斑块负荷相关的未来事件的风险。(C)2003年，由美国心脏病学会基金会提供。
OBJECTIVES The goal of this study was to determine the relative prognostic importance of noninvasive measures of endothelial function and atheroma burden in patients with coronary artery disease (CAD).BACKGROUND Direct measurement of atherosclerosis by carotid ultrasound and endothelial function assessment by brachial artery flow-mediated dilation (FMD) have both been shown to predict vascular events. The combined prognostic utility of carotid ultrasound and FMD relative to traditional risk markers and cardiovascular fitness has not been evaluated.METHODS A total of 152 patients with CAD underwent metabolic testing, exercise stress tests, carotid ultrasound, and endothelial function measurements.RESULTS Patients were followed for 34 +/- 10 months during which 22 vascular events occurred. Peak FMD (p = 0.012) and FMD/nitroglycerin-mediated dilation (NMD) ratio (p = 0.008) were lower in subjects with events. Univariate analysis with Cox proportional hazards modeling identified plaque area (p = 0.0047), total area (p = 0.0085), peak FMD (p = 0.01), FMD/NMD ratio (p = 0.008), stress test workload (p = 0.027), long-acting nitroglycerin (NTG) (p = 0.0071), and calcium blockers (p = 0.0057) as predictors of adverse events. Multivariate analysis showed that FMD/NMD ratio (p < 0.0001), carotid plaque area (p 0.06), and NTG (p = 0.005) were independent predictors. Based on median values, subjects were divided into high and low "plaque burden" groups and into high and low FMD/NMD subgroups. Patients with high FMD/NMD had low event rates irrespective of the degree of carotid atheroma. Patients with low FMD/NMD and high "plaque burden" had the highest event rate (P < 0.05).CONCLUSIONS The structural and functional status of the vasculature are independent predictors of coronary events as shown by noninvasive measurement of endothelial function and carotid atheroma burden in patients with CAD. Preserved endothelial function attenuates the risk of future events associated with a high plaque burden. (C) 2003 by the American College of Cardiology Foundation.