In vivo assessment of endothelial function in human lower extremity arteries.
In vivo assessment of endothelial function in human lower extremity arteries.
复制标题
人体下肢动脉内皮功能的体内评估。
DOI：
10.1016/j.jvs.2013.05.029
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发表时间：
2013
影响因子：
4.3
通讯作者：
Sarac,TimurP
中科院分区：
文献类型：
--
作者：
Kashyap,VikramS;Lakin,RyanO;Feiten,LindsayE;Bishop,PaulD;Sarac,TimurP
在临床前研究中，已经测量了人肱动脉和冠状动脉的内皮功能，但没有测量受动脉粥样硬化影响的下肢动脉的内皮功能。我们描述了一种新的，第一次在人的外周动脉疾病（PAD）患者的股浅动脉（SFA）的内皮功能的评价。血管内超声（IVUS）成像和多普勒血流导丝后，乙酰胆碱（Ach）输注内皮依赖性舒张。计算同一血管的IVUS衍生虚拟组织学。通过输注硝酸甘油（200 μg）测量内皮非依赖性舒张。一氧化氮和血清一氧化氮代谢产物的水平测定实验室analysis.ResultsPatients（48%男性，平均年龄62岁）有高血压（80%），冠心病（36%），糖尿病（40%）的历史。平均SFA直径为5.2 ± 1 mm（范围，3.2-6.9 mm）。患者耐受Ach输注，无不良事件。所有Ach输注量为10− 6至10−4的患者的内皮依赖性舒张功能均高于基线水平。当Ach浓度为10−4时，病变SFA的直径（0.5%）和面积（1.8%）变化不大且不显著;然而，当Ach浓度为10− 6至10− 4时，平均血流峰值速度显著增加26%、46%和63%。在Ach输注后，肢体体积流量的计算（Ach 10−4时为68%）显著增加。下肢一氧化氮水平略低于全身静脉水平（P= 0.04）。硝酸甘油输注表明平滑肌反应性正常（直径为3%，面积为9%，速度较基线变化为116%）。IVUS-虚拟组织学斑块分层显示主要为纤维形态（46%;坏死核心，29%;钙，18%）。动脉粥样硬化负荷为14.9 ± 5.5 mm 3/cm，并没有与内皮responsibility.ConclusionsEndothelial功能可以直接测量人下肢动脉血管疾病的网站。尽管动脉粥样硬化广泛，内皮功能仍然完好无损。这些数据支持在PAD患者中应用局部内皮特异性生物疗法。
ObjectiveEndothelial function has been measured in preclinical studies in human brachial and coronary arteries but not in lower extremity arteries affected by atherosclerosis. We describe a novel, first-in-man evaluation of endothelial function of the superficial femoral arteries (SFAs) in patients with peripheral arterial disease (PAD).MethodsEnrolled were 25 patients with PAD requiring lower extremity angiography. Endothelial-dependent relaxation was measured using intravascular ultrasound (IVUS) imaging and a Doppler flow wire after the infusion of acetylcholine (Ach). IVUS-derived virtual histology of the same vessel was calculated. Endothelial-independent relaxation was measured with an infusion of nitroglycerin (200 μg). Levels of nitric oxide and serum nitric oxide metabolites were determined by laboratory analysis.ResultsPatients (48% male; mean age, 62 years) had a history of hypertension (80%), coronary disease (36%), and diabetes (40%). The mean SFA diameter was 5.2 ± 1 mm (range, 3.2-6.9 mm). Patients tolerated Ach infusion with no adverse events. Endothelial-dependent relaxation increased over baseline for all patients with Ach infusion of 10−6to 10−4. At Ach 10−4, diameter (0.5%) and area (1.8%) changes in the diseased SFAs were modest and insignificant; however, average peak velocity of blood flow significantly increased 26%, 46%, and 63% with an Ach 10−6to 10−4infusion. Calculations of limb volumetric flow (68% at Ach 10−4) were significantly increased after Ach infusion. Lower extremity nitric oxide levels were slightly lower than systemic venous levels (P= .04). Nitroglycerin infusion indicated normal smooth muscle responsiveness (3% diameter, 9% area, and 116% velocity change over baseline). IVUS-virtual histology plaque stratification indicated predominantly fibrous morphology (46%; necrotic core, 29%; calcium, 18%). Atheroma burden was 14.9 ± 5.5 mm3/cm and did not correlate with endothelial responsiveness.ConclusionsEndothelial function can be measured directly in human lower extremity arteries at the sites of vascular disease. Despite extensive atherosclerosis, endothelial function is still intact. These data support the application of regional endothelial-specific biologic therapies in patients with PAD.