CLOSE RELATION OF ENDOTHELIAL FUNCTION IN THE HUMAN CORONARY AND PERIPHERAL CIRCULATIONS
CLOSE RELATION OF ENDOTHELIAL FUNCTION IN THE HUMAN CORONARY AND PERIPHERAL CIRCULATIONS
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DOI：
10.1016/0735-1097(95)00327-4
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发表时间：
1995-11-01
影响因子：
24
通讯作者：
SELWYN, AP
中科院分区：
文献类型：
--
作者：
ANDERSON, TJ;UEHATA, A;SELWYN, AP
目标。在相同的受试者中，研究了血管内皮依赖性的血管扩张功能在同一受试者中的关系。冠状动脉内皮功能障碍是显性动脉粥样硬化发生的先兆，在其发病机制中起重要作用。最近报道了对外周管道血管--臂动脉内皮细胞功能的无创性评估，但尚未探讨臂动脉功能和冠状动脉血管扩张功能之间的关系。对50例冠状动脉病变患者(平均年龄+/-SD56+/-10岁)冠状动脉内连续输注血管内皮依赖性激动剂乙酰胆碱(10(-8)~10(-6)mol/L)的血管运动反应进行了研究。通过测量反应性充血时肱动脉内径的变化来评估血管内皮依赖性的扩张。与冠状动脉内皮功能正常的患者相比，对乙酰胆碱反应表现为血管收缩的冠状动脉内皮功能障碍患者的肱动脉血流介导的血管扩张功能明显受损(4.8±5.5%vs.10.8±7.6%，p<；0.01)。与冠状动脉造影光滑的患者相比，冠心病患者的肱动脉扩张反应也有所减弱(4.5+/-4.6%比9.7+/-8.1%，p<；0.02)。多变量分析显示，对血流反应减弱的最强预测因子是基础臂动脉内径(p<；0.001)、冠状动脉内皮功能障碍(p=0.003)、冠状动脉疾病(p=0.007)和吸烟(p=0.016)。舌下含服硝酸甘油对臂动脉血管扩张的反应与冠状动脉内皮细胞反应或冠状动脉疾病的存在无关。臂部扩张异常的阳性预测价值(
Objectives. The relation between endothelium-dependent vasodilator function in the brachial and coronary arteries was determined in the same subjects.Background. Coronary artery endothelial dysfunction precedes the development of overt atherosclerosis and is important in its pathogenesis. A noninvasive assessment of endothelial function in a peripheral conduit vessel, the brachial artery, nas recently described, but the relation between brachial artery function and coronary artery vasodilator function has not been explored.Methods. In 50 patients referred to the catheterization laboratory for the evaluation of coronary artery disease (mean age +/- SD 56 +/- 10 years), the coronary vasomotor response to serial intracoronary infusions of the endothelium-dependent agonist acetylcholine (10(-8) to 10(-6) mol/liter), was studied. Endothelium-dependent vasodilation was also assessed in the brachial artery by measuring the change in brachial artery diameter in response to reactive hyperemia.Results. Patients with coronary artery endothelial dysfunction manifested as vasoconstriction in response to acetylcholine had significantly impaired flow-mediated vasodilation in the brachial artery compared with that of patients,vith normal coronary endothelial fuuction (4.8 +/- 5.5% vs. 10.8 +/- 7.6%, p < 0.01). Patients,vith coronary artery disease also had an attenuated brachial artery vasodilator response compared with that of patients with angiographically smooth coronary arteries (4.5 +/- 4.6% vs. 9.7 +/- 8.1%, p < 0.02). By multivariate analysis, the strongest predictors of reduced brachial dilator responses to flow were baseline brachial artery diameter (p < 0.001), coronary endotheIial dysfunction (p = 0.003), the presence of coronary artery disease (p = 0.007) and cigarette smoking (p = 0.016). The brachial artery vasodilator response to sublingual nitroglycerin was independent of coronary endothelial responses or the presence of coronary artery disease. The positive predictive value of abnormal brachial dilation (