Elevated endothelin concentrations are associated with reduced coronary vasomotor responses in patients with chest pain and normal coronary arteriograms
Elevated endothelin concentrations are associated with reduced coronary vasomotor responses in patients with chest pain and normal coronary arteriograms
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DOI：
10.1016/s0735-1097(99)00224-7
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发表时间：
1999-08-01
影响因子：
24
通讯作者：
Kaski, JC
中科院分区：
文献类型：
--
作者：
Cox, ID;Botker, HE;Kaski, JC
本研究旨在探讨冠状动脉造影正常（CPNA）的胸痛患者快速心房起搏时动脉和冠状静脉窦内皮素（ET）浓度与冠状动脉血管反应的关系。背景CPNA患者血浆ET浓度显著高于健康对照组。方法对19例CPNA患者进行了仔细的特征性研究，（14名女性;平均年龄53 +/- 9岁），其中10人对运动有积极的心电图反应。采用热稀释起搏导管测定快速心房起搏10分钟后冠状动脉血管阻力（%d.CVR）的下降百分比。血浆ET浓度通过放射免疫测定法同时抽取动脉和冠状窦样本进行测定。结果男性和女性之间ET浓度无显著差异，但有明显的统计学趋势表明，女性的%d.CVR低于男性（27[23至31]% vs. 34[29至45]%-中位数[四分位数间距]; p = 0.07）。仅包括女性（n = 14）的简单回归分析表明，基线动脉ET浓度与%d.CVR之间存在显著相关性（R-2 = 0.34; p = 0.06）。此外，逐步多元回归分析表明，无论是性别，（p = 0.03）和基线动脉ET浓度（p = 0.02）独立预测%d。CVR（R-2 = 0.44;总体p = 0.02）;这种关系预测，ET水平高的女性，结论：这些数据支持这一假设，即在CPNA患者快速心房起搏过程中，ET活性升高可能与冠状动脉血流反应降低有关。(C)1999年由美国心脏病学会。
OBJECTIVES The purpose of this study was to investigate the relationship between arterial and coronary sinus endothelin (ET) concentrations and coronary vasomotor responses during rapid atrial pacing in patients with chest pain and normal coronary arteriograms (CPNA).BACKGROUND Plasma ET concentrations are significantly higher in CPNA patients than in healthy control subjects.METHODS We investigated 19 carefully characterized CPNA patients (14 women; mean age 53 +/- 9 years) of whom 10 had positive electrocardiographic responses to exercise. The percentage fall in coronary vascular resistance (%d.CVR) after 10 min of rapid atrial pacing was determined using a thermodilution pacing catheter. Plasma ET concentrations were measured by radioimmunoassay on simultaneously drawn arterial and coronary sinus samples.RESULTS No significant differences in ET concentrations were observed between men and women, but a strong statistical trend suggested that %d.CVR was lower in women than men (27[23 to 31]% vs. 34[29 to 45]%-median[interquartile range]; p = 0.07). Simple regression analysis including only the women (n = 14) suggested a significant relationship between baseline arterial ET concentrations and %d.CVR (R-2 = 0.34; p = 0.06). Furthermore, stepwise multivariate regression analysis of the group as a whole indicated that both gender (p = 0.03) and baseline arterial ET concentration (p = 0.02) were independently predictive of %d.CVR (R-2 = 0.44; overall p = 0.02); this relationship predicts that women with high ET levels would have the lowest %d.CVR during pacing.CONCLUSIONS These data support the hypothesis that elevated ET activity may be associated with reduced coronary flow responses during rapid atrial pacing in CPNA patients. (C) 1999 by the American College of Cardiology.