Impaired vascular function in patients with Fontan circulation
Impaired vascular function in patients with Fontan circulation
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DOI：
10.1016/j.ijcard.2006.09.020
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发表时间：
2007-08-21
影响因子：
3.5
通讯作者：
Yun, Yong Soo
中科院分区：
文献类型：
--
作者：
Jin, Seon Mi;Noh, Chung Il;Yun, Yong Soo
背景资料：本研究旨在评价Fontan患者的内皮功能，并探讨影响Fontan患者内皮功能的相关因素。测定非Fontan患者的肱动脉血流介导性扩张（FMD）和硝酸甘油诱导性扩张（NG）以及颈总动脉（CCA）内膜-中层厚度（IMT）（n= 44，年龄5 - 29岁，中位数14岁，18名女性）根据标准方案通过高分辨率超声进行。将结果与年龄和性别匹配的对照组进行比较结果：Fontan组FMD和NG较对照组明显减少（P <0.05），而对照组FMD和NG较对照组明显减少（P <0.05（FMD; 6.5 +/- 2.4对比11.1 +/-1.4%，p < 0.001，NG; 13.3 +/- 5.2对比19.4 +/- 6.2%; p= 0.035）。22%的Fontan患者表现为单纯的内皮功能障碍，34%的患者表现为内皮和平滑肌功能障碍。虽然FMD和IMT之间没有相关性，但Fontan患者的颈动脉IMT增加（0.44 +/- 0.07 vs. 0.38 +/- 0.06 mm，p= 0.008）。在多变量分析中，暴露于慢性缺氧的持续时间与FMD呈负相关（p= 0.117，风险比= 1.294，95%置信区间= 0.938-1.786）。血管紧张素转换酶抑制剂（ACEi）治疗组FMD较未治疗组高（7.0 ± 2.5%vs.5.5 ± 2.2%，p= 0.069）。结论：Fontan患者内皮功能障碍较健康对照组更为普遍，既往缺氧是一个独立因素。虽然没有统计学意义，但接受ACEi治疗的患者似乎具有更好的内皮功能。(c)2006爱思唯尔爱尔兰有限公司保留所有权利。
Background: This study was performed to evaluate the endothelial function in Fontan patients, and to investigate the associated factors which influence the endothelial function in these patients.Methods: Flow mediated dilatation (FMD) and nitroglycerin induced dilatation (NG) of the brachial artery, and intima media thickness (IMT) of common carotid artery (CCA) were measured in nonselected Fontan patients (n= 44, age 5 to 29 years, median 14 years, 18 females) by means of high-resolution ultrasound according to the standard protocols. The results were compared to age and sex matched controls (n= 25, age 5 to 27 years, median 13 years, 10 females).Results: Fontan patients presented significantly reduced FMD and NG compared with controls (FMD; 6.5 +/- 2.4 vs. 11.1 +/- 1.4%, p < 0.001, NG; 13.3 +/- 5.2 vs. 19.4 +/- 6.2%; p= 0.035). Twenty two percent of Fontan patients presented pure endothelial dysfunction, and 34% of patients presented combined endothelial and smooth muscle dysfunction. Although there was no correlation between FMD and IMT, Fontan patients presented increased carotid IMT (0.44 +/- 0.07 vs. 0.38 +/- 0.06 mm, p= 0.008). In multivariate analysis, duration of exposure to chronic hypoxia was inversely correlated with FMD (p= 0.117, hazards ratio= 1.294, 95% confidence interval= 0.938-1.786). There was higher FMD in patients receiving angiotensin-converting enzyme inhibitors (ACEi) compared with those not receiving ACEi ( 7.0 +/- 2.5 vs. 5.5 +/- 2.2%, p= 0.069).Conclusions: Endothelial dysfunction is more prevalent in Fontan patients compared with healthy controls, and the previous hypoxia is an independent factor. Although it is not statistically significant, those patients on treatment with ACEi seem to have better endothelial function. (c) 2006 Elsevier Ireland Ltd. All rights reserved.