Wu Wen-Chih, Sharma Satish C, Choudhary Gaurav, Coulter Linda, Coccio Elizabeth, Eaton Charles B
Division of Cardiology, Providence VA Medical Center, Brown Medical School, 830 Challkstone, Providence, RI 02908, USA.
J Nucl Cardiol. 2005 Sep-Oct;12(5):538-44. doi: 10.1016/j.nuclcard.2005.04.017.
Endothelial function can be measured by flow-mediated vasodilation (FMD) of the brachial artery and has been associated with cardiac risk factors (RF) and angiographically defined coronary artery disease (CAD). Stress single photon emission computed tomography (SPECT) imaging is commonly used to study patients with CAD. We sought to study the relationship between endothelial dysfunction by FMD and stress thallium SPECT to detect CAD.
Fifty-five consecutive patients with chest pain syndrome referred for stress SPECT and eleven healthy control subjects had FMD measured on the brachial artery by standard techniques. The main outcome was the percent of brachial artery diameter dilation from baseline and the number of perfusion defects by SPECT. In subjects with no RF, those with RF but no defects, and those with defects, the mean FMD was 18.88% +/- 2.31%, 7.85% +/- 1.66%, and 5.91% +/- 1.07%, respectively (P < .05). A significant correlation was found between the number of thallium defects and degree of FMD impairment (r = -0.40, P < .01). An FMD cutoff value of less than 7.5% had a 72.5% sensitivity and 73.1% specificity in predicting the presence of any thallium defects. After RF adjustment, FMD remained as the strongest predictor of scintigraphic CAD (odds ratio, 10.96; 95% confidence interval, 2.82-57.31).
FMD independently predicts the presence and extent of scintigraphic CAD.
内皮功能可通过肱动脉的血流介导的血管舒张(FMD)来测量,并且与心脏危险因素(RF)以及血管造影定义的冠状动脉疾病(CAD)相关。负荷单光子发射计算机断层扫描(SPECT)成像常用于研究CAD患者。我们试图研究通过FMD检测的内皮功能障碍与负荷铊SPECT之间的关系,以检测CAD。
连续55例因胸痛综合征接受负荷SPECT检查的患者以及11名健康对照者通过标准技术测量肱动脉的FMD。主要结局是肱动脉直径相对于基线的扩张百分比以及SPECT的灌注缺损数量。在无RF的受试者、有RF但无缺损的受试者以及有缺损的受试者中,平均FMD分别为18.88%±2.31%、7.85%±1.66%和5.91%±1.07%(P<.05)。发现铊缺损数量与FMD受损程度之间存在显著相关性(r=-0.40,P<.01)。FMD临界值小于7.5%在预测任何铊缺损的存在方面具有72.5%的敏感性和73.1%的特异性。在调整RF后,FMD仍然是闪烁扫描CAD的最强预测因子(优势比,10.96;95%置信区间,2.82-57.31)。
FMD可独立预测闪烁扫描CAD的存在及程度。