Peripheral vascular endothelial function testing for the diagnosis of coronary artery disease
Peripheral vascular endothelial function testing for the diagnosis of coronary artery disease
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DOI：
10.1016/j.ahj.2004.04.016
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发表时间：
2004-10-01
影响因子：
4.8
通讯作者：
Picano, E
中科院分区：
文献类型：
--
作者：
Jambrik, Z;Venneri, L;Picano, E
背景内皮依赖性血管舒张功能的减弱可以在动脉粥样硬化发展之前检测到，并且它们的存在可以预测通过ST段压低和/或灌注缺陷评估的应激诱导的缺血。反应性充血期间的肱动脉超声是一种通过血流介导的血管舒张（FMD）评估外周血管运动的无创方法。本研究的目的是评估是否内皮依赖性FMD的肱动脉，超声成像，预测血管造影评估的冠状动脉疾病（CAD）的存在。方法一百九十八名住院患者（年龄，59 +/- 9岁; 78名妇女）胸痛综合征，没有以前的心肌梗死或血运重建程序被纳入本研究。所有患者在测试时均未接受硝酸盐治疗，并在不同日期接受冠状动脉造影和高分辨率超声肱动脉内皮依赖性FMD测试。血流介导的扩张（%FMD）的结果定义为反应性充血期间肱动脉内径相对于基线的百分比变化。如果冠状动脉血管的直径在定量计算机辅助分析中缩小了50%或更多，则认为该血管有明显的阻塞。结果69例冠心病患者的FMD %低于129例非冠心病患者（4.64% +/-4.36%vs 7.39% +/- 5.68%; P = 0.01）。通过多变量分析，%FMD（P = 0.01;比值比[OR]，1.13; 95%置信区间[CI]，1.05至1.23）、男性（P = 0.01; OR，3.47; 95% CI，1.64至7.36）和吸烟习惯（P
Background Abnormalities in endothelium-dependent vasodilation may be detected in arteries before the development of overt atherosclerosis, and their presence may predict stress-induced ischemia as assessed by ST-segment depression and/or perfusion defects. Brachial artery ultrasound during reactive hyperemia is a noninvasive method of assessing peripheral vasomotion, measured by flow-mediated vasodilation (FMD). The purpose of the current study was to assess whether endothelium-dependent FMD of the brachial artery, by ultrasound imaging, predicts the presence of angiographically assessed coronary artery disease (CAD).Methods One hundred ninety-eight in-hospital patients (age, 59 +/- 9 years; 78 women) with chest pain syndrome and without previous myocardial infarction or revascularization procedures were enrolled in the present study. All of the patients, at testing time, were not receiving nitrate therapy and underwent, on different days, coronary angiography and endothelium-dependent FMD testing of the brachial artery by high-resolution ultrasound. The result of the flow-mediated dilation (%FMD) is defined as the percent change in the internal diameter of the brachial artery during reactive hyperemia related to baseline. A coronary vessel was considered to have a significant obstruction if its diameter was narrowed by 50% or more on quantitative computer-assisted analysis. A prognostically validated angiographic Duke score (from 0 normal to -100 = severe left main disease) was calculated.Results The %FMD was lower in patients with (n = 69) compared with those without (n = 129) CAD (4.64% +/- 4.36% vs 7.39% +/- 5.68%; P =.01). By multivariate analysis, the %FMD (P =.01; odds ratio [OR], 1.13; 95% confidence interval [CI], 1.05 to 1.23), male sex (P =.01; OR, 3.47; 95% Cl, 1.64 to 7.36), and cigarette smoking habit (P