Eryol Namik Kemal, Topsakal Ramazan, Ciçek Yüksel, Abaci Adnan, Oguzhan Abdurahman, Basar Emrullah, Ergin Ali
Department of Cardiology, Erciyes University Medical School, Kayseri, Turkey.
Jpn Heart J. 2002 May;43(3):219-30. doi: 10.1536/jhj.43.219.
We hypothesized that the change in aortic elastic properties could directly be shown with color Doppler tissue imaging (CDTI), that these findings could be related to aortic stiffness and distensibility and that, through these, coronary artery disease (CAD) could be predicted. One hundred and twenty six patients (group I: 83 with CAD, mean age 54+/-10 years, 18 female, 65 male; group II: 43 without CAD, mean age 53+/-10 years, 27 female, 16 male) having been evaluated for coronary artery disease by angiography were examined by echocardiography. Arterial pressure was measured immediately before echocardiographic evaluation. Internal aortic systolic and diastolic diameters by M-mode echocardiography and aortic upper wall tissue velocities (Aortic S, E, A, m/sec) by CDTI were measured 3 cm above the aortic valve. Lateral mitral annulus tissue velocities (Annulus S, E, A, m/sec) were also recorded. Aortic distensibility (cm2 x dynes(-1)) and aortic stiffness index were calculated using formulas. In the statistical analyses, CAD risk factors and left ventricular ejection fraction were used for adjustment. Aortic stiffness (2.79+/-3.49 vs 1.62+/-1.31, P=0.03), distensibility (1.55+/-1.46 vs 2.37+/-3.08, P=0.04), and aortic S velocity (0.057+/-0.016 vs 0.064+/-0.015, P=0.02) differed significantly between groups I and II. After adjustment, while aortic stiffness and S velocity were still statistically different (P=0.04; P=0.03 respectively), the significance of the difference in aortic distensibility disappeared (P=0.051). Aortic stiffness and aortic S velocity (0.06 m/sec<) were important CAD determinants (Odds ratio=1.4 P=0.03; Odds ratio=3.6 P=0.01, respectively), but aortic distensibility was not. Aortic stiffness was correlated only with aortic S velocity (r=-0.28, P=0.01), and aortic distensibility had a significantly positive correlation with aortic S velocity (r=0.20, P=0.02). The interobserver and intraobserver correlation coefficients for aortic S velocities were 0.65 and 0.71, respectively (P<0.05). Elastic properties of the aorta can directly be assessed by reproducibly measuring the movements in the upper wall of the aorta by CDTI. Reduced aortic S velocity is associated with increased aortic stiffness. Increased aortic stiffness and reduced aortic S velocity are important predictors of CAD.
我们假设，主动脉弹性特性的变化可以通过彩色多普勒组织成像（CDTI）直接显示出来，这些发现可能与主动脉僵硬度和扩张性有关，并且通过这些，可以预测冠状动脉疾病（CAD）。对126例接受冠状动脉造影评估冠状动脉疾病的患者（第一组：83例CAD患者，平均年龄54±10岁，女性18例，男性65例；第二组：43例无CAD患者，平均年龄53±10岁，女性27例，男性16例）进行了超声心动图检查。在超声心动图评估前立即测量动脉压。通过M型超声心动图测量主动脉内收缩期和舒张期直径，并通过CDTI测量主动脉瓣上方3 cm处的主动脉上壁组织速度（主动脉S、E、A，m/秒）。还记录了二尖瓣环外侧组织速度（瓣环S、E、A，m/秒）。使用公式计算主动脉扩张性（cm2×达因-1）和主动脉僵硬度指数。在统计分析中，使用CAD危险因素和左心室射血分数进行校正。第一组和第二组之间的主动脉僵硬度（2.79±3.49对1.62±1.31，P = 0.03）、扩张性（1.55±1.46对2.37±3.08，P = 0.04）和主动脉S速度（0.057±0.016对0.064±0.015，P = 0.02）有显著差异。校正后，虽然主动脉僵硬度和S速度仍有统计学差异（分别为P = 0.04；P = 0.03），但主动脉扩张性差异的显著性消失（P = 0.051）。主动脉僵硬度和主动脉S速度（<0.06 m/秒）是重要的CAD决定因素（优势比分别为1.4，P = 0.03；优势比为3.6，P = 0.01），但主动脉扩张性不是。主动脉僵硬度仅与主动脉S速度相关（r = -0.28，P = 0.01），主动脉扩张性与主动脉S速度有显著正相关（r = 0.20，P = 0.02）。主动脉S速度的观察者间和观察者内相关系数分别为0.65和0.71（P < 0.05）。通过CDTI可重复测量主动脉上壁的运动，从而直接评估主动脉的弹性特性。主动脉S速度降低与主动脉僵硬度增加有关。主动脉僵硬度增加和主动脉S速度降低是CAD的重要预测指标。
