Prognostic value of coronary vascular endothelial dysfunction
Prognostic value of coronary vascular endothelial dysfunction
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DOI：
10.1161/01.cir.0000025404.78001.d8
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发表时间：
2002-08-06
期刊：
影响因子：
37.8
通讯作者：
Quyyumi, AA
中科院分区：
文献类型：
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作者：
Halcox, JPJ;Schenke, WH;Quyyumi, AA
冠状动脉血管功能测试可以从相对较低的风险人群中鉴定出风险增加的背景患者仍然未知。我们调查了冠状动脉内皮功能与急性不可预测的心血管事件（心血管死亡，心肌梗塞，中风和不稳定的心绞痛）之间的关系。血管抗性（DeltaCVR）和心外膜直径为冠状动脉内乙酰胆碱（ACH，15杯/min）以测试内皮依赖性功能和硝化钠（20毫克/分钟）和腺苷（2.2 mg/min），以测试308例接受心脏导管（132例）患者（132）（132）（132）（132）（132） 176没有CAD）。患者的临床随访平均为46 +/- 3个月。 35例患者发生急性血管事件。经过多变量分析（包括CAD和传统风险因素的动脉粥样硬化，DeltaCVR），具有ACH（P = 0.02）和ACH的心外膜收缩（P = 0.003），以及年龄，CAD和体重指数的增加，是不良事件的独立预测指标。 。因此，第三级的患者与ACH具有最佳的微血管反应，而心外膜扩张的患者和ACH的患者在总人群中的Kaplan-Meier分析可以提高生存率，而没有CAD的子集中的患者也是如此。当考虑了所有不良事件（包括血运重建）时，还观察到了类似的生存改善。独立的反应并不能预测结果。结论 - 心脏和微血管冠状动脉内皮功能障碍独立预测有或没有CAD的患者的急性心血管事件，提供功能性和预后信息，以补充血管造影和风险因素评估。
Background-Whether patients at increased risk can be identified from a relatively low-risk population by coronary vascular function testing remains unknown. We investigated the relationship between coronary endothelial function and the occurrence of acute unpredictable cardiovascular events (cardiovascular death, myocardial infarction, stroke, and unstable angina) in patients with and without coronary atherosclerosis (CAD).Methods and Results-We measured the change in coronary vascular resistance (DeltaCVR) and epicardial diameter with intracoronary acetylcholine (ACh, 15 mug/min) to test endothelium-dependent function and sodium nitroprusside (20 mug/min) and adenosine (2.2 mg/min) to test endothelium-independent vascular function in 308 patients undergoing cardiac catheterization (132 with and 176 without CAD). Patients underwent clinical follow-up for a mean of 46 +/- 3 months. Acute vascular events occurred in 35 patients. After multivariate analysis that included CAD and conventional risk factors for atherosclerosis, DeltaCVR with ACh (P=0.02) and epicardial constriction with ACh (P=0.003), together with increasing age, CAD, and body mass index, were independent predictors of adverse events. Thus, patients in the tertile with the best microvascular responses with ACh and those with epicardial dilation with ACh had improved survival by Kaplan-Meier analyses in the total population, as did those in the subset without CAD. Similar improvement in survival was also observed when all adverse events, including revascularization, were considered. Endothelium-independent responses were not predictive of outcome.Conclusions-Epicardial and microvascular coronary endothelial dysfunction independently predict acute cardiovascular events in patients with and without CAD, providing both functional and prognostic information that complements angiographic and risk factor assessment.