Schröder S, Enderle M D, Meisner C, Baumbach A, Herdeg C, Oberhoff M, Ossen R, Pfohl M, Karsch K R
Abteilung für Kardiologie, Eberhard-Karls-Universität Tübingen.
Dtsch Med Wochenschr. 1999 Jul 30;124(30):886-90. doi: 10.1055/s-2007-1024435.
A positive correlation between the presence of coronary artery disease (CAD) and peripheral endothelial dysfunction (ED) of the brachial artery has been shown in several studies. Aim of the present study was to evaluate whether the non-invasive determination of ED could also be used as a screening test in patients suspected of having CAD.
122 patients were included. 112 had an exercise-ECG before hospital admission. Preceding coronary angiography, FMD% was measured by high-resolution ultrasound (13 Mhz). Longitudinal scans of the brachial artery were done at rest, during reactive hyperemia and after the sublingual administration of nitroglycerin.
In 101 of the 122 patients the presence of CAD was diagnosed by angiography, whereas 21 patients had normal coronary arteries. The extent of the vasodilation (FMD%) was found to be largely independent of the resting vessel diameters (FMD%/vessel diameter at rest: r = -0.32767 p = 0.0002). FMD% was significantly higher in patient without CAD than in the CAD group (7.01 +/- 3.5% vs. 3.73 +/- 4.11%, p < 0.001). Comparison of sensitivity and specificity to predict the presence of CAD between FMD% [sensitivity 71.3%, specificity 81%] and exercise-ECG [sensitivity 82.4%, specificity 57.1%] gave similar results. No correlation was found between the degree of the impairment of FMD% and the severely of CAD.
The determination of peripheral ED was found to be a sensitive and specific measure for predicting the presence of CAD in our cohort. Since this approach is non-invasive, non-radioactive and cost-effective it warrants further evaluation of its role as an additional screening test in patients clinically suspected of having CAD.
多项研究表明，冠状动脉疾病（CAD）的存在与肱动脉外周内皮功能障碍（ED）之间存在正相关。本研究的目的是评估ED的非侵入性测定是否也可用于疑似CAD患者的筛查试验。
纳入122例患者。112例在入院前进行了运动心电图检查。在冠状动脉造影之前，通过高分辨率超声（13兆赫）测量血流介导的血管舒张百分比（FMD%）。在静息状态、反应性充血期间和舌下含服硝酸甘油后，对肱动脉进行纵向扫描。
122例患者中，101例通过血管造影诊断为CAD，而21例患者冠状动脉正常。发现血管舒张程度（FMD%）在很大程度上与静息血管直径无关（FMD%/静息时血管直径：r = -0.32767，p = 0.0002）。无CAD患者的FMD%显著高于CAD组（7.01±3.5%对3.73±4.11%，p < 0.001）。FMD%[敏感性71.3%，特异性81%]和运动心电图[敏感性82.4%，特异性57.1%]预测CAD存在的敏感性和特异性比较结果相似。未发现FMD%受损程度与CAD严重程度之间存在相关性。
在我们的队列中，外周ED的测定被发现是预测CAD存在的一种敏感且特异的方法。由于这种方法是非侵入性、无放射性且具有成本效益的，因此有必要进一步评估其作为临床疑似CAD患者额外筛查试验的作用。
