Sitges Marta, Roig Eulàlia, Morales Manel, Azqueta Manel, Pérez Villa Félix, Paré Carles, Orús Josefina, Heras Magda, Sanz Ginés
Institut de Malalties Cardiovasculars, Hospital Clínic, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Universidad de Barcelona, Barcelona, España.
Rev Esp Cardiol. 2005 May;58(5):477-83.
Endothelial dysfunction has been found in patients with idiopathic dilated cardiomyopathy (IDC), but its mechanism remains unknown. Our aim was to investigate whether forearm endothelium-dependent vasoreactivity correlates with cardiac disease severity or neurohormonal activation.
We studied 23 patients with IDC and 10 healthy sex- and age-matched controls using brachial artery ultrasound to assess flow-mediated dilation (FMD) and nitroglycerin-induced vasodilation (NIV). In the IDC group, we determined plasma neurohormone and cytokine levels at the same time.
FMD was significantly less in the IDC group compared with the control group [--0.06 (2.8)% vs 4.4 (4.6)%, respectively; P<.01], whereas NIV was similar in both groups [15.0 (6.4)% vs 14.0 (7.4)%, respectively; P=NS]. FMD was significantly less in patients with poorer left ventricular (LV) function and more severe LV dilatation, and in those with a higher tumor necrosis factor-alpha (TNF-alpha) level. NIV was similar in all patient subgroups. There was a significant inverse correlation between the TNF-alpha plasma level and FMD (r=-0.75; P<.01). No correlation was found between the plasma levels of other neurohormones and FMD.
FMD, but not NIV, was impaired in patients with IDC compared with control subjects. In patients, there were significant associations between FMD impairment and the severity of LV dilatation, the severity of LV systolic dysfunction, and the plasma TNF-alpha level. The strongest correlation was observed between TNF-alpha plasma level and FMD. These data suggest that TNF-alpha may be implicated in endothelial dysfunction in patients with IDC.
在特发性扩张型心肌病（IDC）患者中已发现存在内皮功能障碍，但其机制仍不清楚。我们的目的是研究前臂内皮依赖性血管反应性是否与心脏疾病严重程度或神经激素激活相关。
我们使用肱动脉超声评估血流介导的血管舒张（FMD）和硝酸甘油诱导的血管舒张（NIV），对23例IDC患者和10名年龄及性别匹配的健康对照者进行了研究。在IDC组中，我们同时测定了血浆神经激素和细胞因子水平。
与对照组相比，IDC组的FMD明显降低[分别为-0.06（2.8）%对4.4（4.6）%；P<0.01]，而两组的NIV相似[分别为15.0（6.4）%对14.0（7.4）%；P=无统计学意义]。左心室（LV）功能较差、LV扩张更严重以及肿瘤坏死因子-α（TNF-α）水平较高的患者，其FMD明显更低。所有患者亚组的NIV相似。TNF-α血浆水平与FMD之间存在显著负相关（r=-0.75；P<0.01）。未发现其他神经激素血浆水平与FMD之间存在相关性。
与对照受试者相比，IDC患者的FMD受损，而NIV未受损。在患者中，FMD受损与LV扩张严重程度、LV收缩功能障碍严重程度以及血浆TNF-α水平之间存在显著关联。观察到TNF-α血浆水平与FMD之间的相关性最强。这些数据表明，TNF-α可能与IDC患者的内皮功能障碍有关。
