Cardiovascular outcome of patients with abnormal coronary vasomotion and normal coronary arteriography is worse in type 2 diabetes mellitus than in arterial hypertension: A 10 year follow-up study
Cardiovascular outcome of patients with abnormal coronary vasomotion and normal coronary arteriography is worse in type 2 diabetes mellitus than in arterial hypertension: A 10 year follow-up study
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DOI：
10.1016/j.atherosclerosis.2005.02.030
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发表时间：
2005-11-01
期刊：
影响因子：
5.3
通讯作者：
Chemla, D
中科院分区：
文献类型：
--
作者：
Nitenberg, A;Pham, I;Chemla, D
糖尿病和动脉高血压是主要的心血管危险因素。冠状动脉内皮功能障碍在糖尿病和高血压患者中常见。本研究旨在比较冠状动脉造影正常的高血压（HT）和2型糖尿病患者（D2）心血管结局的基础上，他们的心外膜冠状动脉内皮功能。采用定量冠状动脉造影术，通过冷加压试验（CPT）对65例HT（45例男性，20例女性）和59例D2（32例男性，27例女性）进行冠状动脉反应性评估，年龄分别为51.9 ± 7.6岁和48.9 ± 7.3岁，冠状动脉造影正常且无其他主要冠状动脉危险因素。心血管事件（CVE）记录与平均随访108 15个月的HT，和113 10个月的D2。CPT时HT时冠状动脉扩张10.8%，无变化21.5%，狭窄67.7%。D2时，3.4%的患者出现扩张，18.6%的患者无变化，78.0%的患者出现收缩。随访期间，HT组6/65例（9.2%）患者发生9例CVE，均发生在6/44例（13.6%）冠状动脉狭窄患者中。D2时，16/59例患者（27. 7%）发生了18例CVE。46例冠状动脉狭窄患者中15例发生17次心血管事件（32.6%），13例无狭窄患者中1例发生1次心血管事件（7.7%）。冠状动脉狭窄患者中，D2期的CVE发生率高于HT期（P < 0.05）。D_2期脑静脉栓塞较HT期严重且发生早。总之，心外膜冠状动脉内皮功能不全是冠状动脉造影正常的HT和D2患者长期CVE的预测因素。冠状动脉狭窄患者的心血管结局在D2组比HT组更差。相反，在两个亚组中，无缩窄的患者具有良好的心血管预后。(c)2005爱思唯尔爱尔兰有限公司保留所有权利。
Diabetes and arterial hypertension are major cardiovascular risk factors. Coronary endothelial dysfunction is frequently observed in diabetic and hypertensive patients. This study was designed to compare cardiovascular outcome of hypertensive (HT) and type 2 diabetic patients (D2) with angiographically normal coronary arteries on the basis of their epicardial coronary endothelial function. Coronary reactivity assessment by cold-pressor test (CPT) using quantitative coronary angiography was achieved in 65 HT (45 males, 20 females) aged 51.9 +/- 7.6 years, and in 59 D2 (32 males, 27 females) aged 48.9 +/- 7.3 years, with angiographically normal coronary arteries and without other major coronary risk factor. Cardiovascular events (CVE) were recorded with a mean follow-up of 108 15 months in HT, and 113 10 months in D2. During CPT, in HT coronary artery dilation occurred in 10.8% of the patients, no change in 21.5%, and constriction in 67.7%. In D2, dilation occurred in 3.4% of the patients, no change in 18.6%, and constriction in 78.0%. During follow-up, in HT there were nine CVE in 6/65 patients (9.2%), all in the 6/44 (13.6%) patients with coronary artery constriction. In D2, there were 18 CVE in 16/59 patients (27. 1 %, P < 0.0 1 versus HT), with 17 CVE in the 15/46 patients with coronary artery constriction, and one CVE in the 1/ 13 patients without constriction (32.6% versus 7.7%). In patients with coronary artery constriction, CVE were more frequent in D2 than in HT (P < 0.05). Last, CVE were more severe and occurred earlier in D2 than in HT. In conclusion, epicardial coronary endothelial dysfunction is predictive of long-term CVE in HT and D2 with angiographically normal coronary arteries. Cardiovascular outcome of patients with coronary constriction is worse in D2 than in HT. At the opposite, patients without constriction have good cardiovascular prognosis in both subgroups. (c) 2005 Elsevier Ireland Ltd. All rights reserved.