Endothelial function predicts future development of coronary artery disease - A study of women with chest pain and normal coronary angiograms
Endothelial function predicts future development of coronary artery disease - A study of women with chest pain and normal coronary angiograms
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DOI：
10.1161/01.cir.0000128208.22378.e3
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发表时间：
2004-06-01
期刊：
影响因子：
37.8
通讯作者：
Morgagni, G
中科院分区：
文献类型：
--
作者：
Bugiardini, R;Manfrini, O;Morgagni, G
背景-胸痛和冠状动脉造影正常的女性预后被认为是完全良性的。然而，之前的研究并没有考虑到女性可能经历的冠状动脉疾病发展延迟十年左右的原因。方法和结果：本研究评估了42例新发心绞痛妇女的长期随访，SPECT显示可逆性心肌灌注缺陷，冠状动脉造影正常。招募时，所有女性在插管期间进行内皮功能测试（冠状动脉内乙酰胆碱）。患者随访10年。37例患者在随访结束时重复血管造影。在招募时，22例患者在乙酰胆碱治疗期间出现弥漫性血管收缩，但没有可识别的局灶性冠状动脉痉挛（乙酰胆碱阳性组）。剩余20例出现血管舒张（乙酰胆碱阴性组）。随访结束时，乙酰胆碱阳性组1例发生心源性死亡，13例仍主诉胸痛，8例症状缓解。在乙酰胆碱阴性组中，所有患者在基线评估后6至36个月开始胸痛完全消退。血管造影显示13例有症状的乙酰胆碱阳性组患者出现冠状动脉病变。结论：冠状动脉造影显示正常的女性，胸痛持续多年往往与冠状动脉疾病的发展有关。正常冠状动脉的内皮功能障碍是未来动脉粥样硬化发展的标志。
Background - The prognosis for women with chest pain and angiographically normal coronary arteries is believed to be totally benign. Previous studies, however, did not account for the delay of a decade or so in the development of coronary artery disease that women may experience.Methods and Results - This study assessed long-term follow-up of 42 women with de novo angina, evidence of reversible myocardial perfusion defects on SPECT, and normal coronary angiograms. At recruitment, all women underwent endothelial function testing (intracoronary acetylcholine) during catheterization. Patients were followed up for > 10 years. Angiography was repeated at the end of the follow-up in 37 patients. At recruitment, 22 patients developed diffuse vasoconstriction during acetylcholine in the absence of identifiable focal coronary spasm (acetylcholine-positive group). The remaining 20 patients showed vasodilation (acetylcholine-negative group). At the end of follow-up, in the acetylcholine-positive group, 1 patient developed cardiac death, 13 still complained of chest pain, and 8 had remission of symptoms. In the acetylcholine-negative group, all patients showed complete resolution of chest pain beginning 6 to 36 months after baseline assessment. Angiography showed development of coronary artery disease in the 13 symptomatic patients in the acetylcholine-positive group.Conclusions - In women with angiographically normal-appearing coronary arteries, persistence of chest pain over the years often relates to development of coronary artery disease. Endothelial dysfunction in a setting of normal coronary arteries is a sign of future development of atherosclerosis.