Predictive value of noninvasively determined endothelial dysfunction for long-term cardiovascular events in patients with peripheral vascular disease
Predictive value of noninvasively determined endothelial dysfunction for long-term cardiovascular events in patients with peripheral vascular disease
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DOI：
10.1016/s0735-1097(03)00333-4
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发表时间：
2003-05-21
影响因子：
24
通讯作者：
Vita, JA
中科院分区：
文献类型：
--
作者：
Gokce, N;Keaney, JF;Vita, JA
目的：本研究的目的是前瞻性地研究臂动脉内皮细胞功能障碍对未来心血管事件的长期预测价值。背景：在有动脉粥样硬化和冠状动脉危险因素的个体中，臂动脉内皮细胞功能受损。通过臂动脉超声测定的内皮功能与长期心血管风险之间的预期关系尚不清楚。方法我们在择期血管手术前对199例外周动脉疾病患者进行了肱动脉内皮功能的超声检测。结果35例患者术后发生心源性死亡(5例)、心肌梗塞(17例)、不稳定型心绞痛(10例)、中风(3例)。发生事件的患者术前血管内皮依赖性血流介导的舒张率(4.4+/-2.8%)显著低于无事件患者(7.0+/-4.9%，p<；0.001)，而硝酸甘油的非内皮依赖性血管扩张作用在两组中相似。在COX比例风险模型中，事件的独立预测因素包括年龄(p=0.003)、更具侵入性的手术(除颈动脉内膜切除术外，p=0.02)和臂动脉内皮功能受损(p=0.002)。口蹄疫患者的风险大约高出九倍
OBJECTIVES The goal of this study was to prospectively examine the long-term predictive value of brachial-artery endothelial dysfunction for future cardiovascular events.BACKGROUND Brachial-artery endothelial function is impaired in individuals with atherosclerosis and coronary risk factors. The prospective relation between endothelial function determined by brachial-artery ultrasound and long-term cardiovascular risk is unknown.METHODS We examined brachial-artery endothelial function using ultrasound in 199 patients with peripheral arterial disease before elective vascular surgery. Patients were prospectively followed with an average follow-up of 1.2 years after surgery.RESULTS Thirty-five patients had an event during follow-up, including cardiac death (5 patients), myocardial infarction (17 patients), unstable angina (10 patients), or stroke (3 patients). Preoperative endothelium-dependent flow-mediated dilation (FMD) was significantly lower in patients with an event (4.4 +/- 2.8%) compared with those without an event (7.0 +/- 4.9%, p < 0.001), whereas endothelium-independent vasodilation to nitroglycerin was similar in both groups. In a Cox proportional-hazards model, independent predictors of events included age (p = 0.003), more invasive surgery (surgery other than carotid endarterectomy, p = 0.02), and impaired brachial-artery endothelial function (p = 0.002). Risk was approximately nine-fold higher in patients with FMD