Jadhav Uday M, Sivaramakrishnan Anand, Kadam N N
Department of Non-Invasive Cardiology, MGM New Bombay Hospital, Vashi, Navi Mumbai.
Indian Heart J. 2003 Jan-Feb;55(1):44-8.
A noninvasive technique for testing endothelial function by ultrasound measurement of flow-mediated dilatation has recently generated considerable interest as a marker of atherosclerosis, and in the prediction of clinical coronary events and coronary artery disease.
We measured the flow-mediated dilatation of the brachial artery (endothelium-dependent vasodilatation) in 136 subjects, with or without evidence of coronary artery disease. Endothelial dysfunction was diagnosed if flow-mediated dilatation was less than 4.5%. Of the 136 subjects (age group 40-70 years) recruited for the study, 94 were males and 42 females. Sixty-eight subjects had evidence of coronary artery disease as diagnosed by documented hospitalization due to myocardial infarction or acute coronary syndrome, proved by coronary angiography when feasible or noninvasive cardiac evaluation. Endothelial dysfunction was detected in 90 subjects (66.2%). Prevalence of coronary artery disease was higher among subjects with endothelial dysfunction compared to those without (57.5% v. 34.7%, p=0.013). Prevalence of endothelial dysfunction was significantly higher among subjects with coronary artery disease as compared to those without coronary artery disease (76.4% v. 55.8%, p=0.012). The present study showed a sensitivity of 76%, specificity of 44%, positive predictive value of 58% and negative predictive value of 65% for endothelial dysfunction in the prediction of coronary artery disease. Multiple regression analysis using coronary artery disease as a dependent variable revealed a statistically significant association with endothelial dysfunction (p=0.033) even after the inclusion of traditional risk factors into the model.
We conclude that endothelial dysfunction shows a strong association with coronary artery disease and can be a useful noninvasive tool for the evaluation of coronary artery disease.
一种通过超声测量血流介导的血管扩张来检测内皮功能的非侵入性技术，最近作为动脉粥样硬化的标志物以及临床冠状动脉事件和冠状动脉疾病的预测指标引起了广泛关注。
我们测量了136名有或无冠状动脉疾病证据的受试者肱动脉的血流介导的血管扩张（内皮依赖性血管舒张）。如果血流介导的血管扩张小于4.5%，则诊断为内皮功能障碍。在本研究招募的136名受试者（年龄在40 - 70岁之间）中，男性94名，女性42名。68名受试者有冠状动脉疾病的证据，这些证据通过因心肌梗死或急性冠状动脉综合征住院记录确诊，在可行时通过冠状动脉造影或无创心脏评估予以证实。90名受试者（66.2%）检测到内皮功能障碍。与无内皮功能障碍的受试者相比，有内皮功能障碍的受试者中冠状动脉疾病的患病率更高（57.5%对34.7%，p = 0.013）。与无冠状动脉疾病的受试者相比，有冠状动脉疾病的受试者中内皮功能障碍的患病率显著更高（76.4%对55.8%，p = 0.012）。本研究显示，内皮功能障碍预测冠状动脉疾病的敏感性为76%，特异性为44%，阳性预测值为58%，阴性预测值为65%。以冠状动脉疾病为因变量的多元回归分析显示，即使将传统危险因素纳入模型后，内皮功能障碍与之仍存在统计学显著关联（p = 0.033）。
我们得出结论，内皮功能障碍与冠状动脉疾病密切相关，可作为评估冠状动脉疾病的有用无创工具。
