Takase Bonpei, Hamabe Akira, Satomura Kimio, Akima Takasi, Uehata Akimi, Matsui Takemi, Ohsuzu Fumitaka, Ishihara Masayuki, Kurita Akira
National Defense Medical College Research Institute, Division of Biomedical Engineering and Internal Medicine-1, Tokorozawa, Saitama, Japan.
Circ J. 2006 Jan;70(1):49-56. doi: 10.1253/circj.70.49.
Vasodilator response to acetylcholine (ACh) (ie, endothelium-dependent dilation) is impaired in the peripheral and coronary circulation of patients with coronary risk factors and coronary artery disease (CAD). There is a close relationship of vasodilator response to ACh in both the coronary artery (CA) and the brachial artery (BA), but the comparative prognostic importance of these responses has not been fully investigated in relatively low-risk suspected CAD.
The flow responses of both the CA and BA were measured in 70 patients with suspected CAD, excluding patients with triple-vessel disease and known peripheral or cerebrovascular disorders. A Doppler guidewire was placed into a major branch of the CA and a proximal portion of the left BA. ACh was infused at 10(-8), 10(-7) and 10(-6) mol/L for 3 min into the CA and at 7.5, 15, and 30 mug/min for 5 min into BA. The flow response was obtained by multiplying the average peak velocity by the cross-sectional area from quantitative angiography. Vasodilator response to ACh was assessed by the ratio of ACh-induced flow/baseline flow, expressed as coronary blood flow index (CBFI) or brachial blood flow index (BBFI). There were 39 CAD patients (61 +/- 8 years old) and 31 normal coronary patients (NL, 58 +/- 11 years old) who were followed up for 53 +/- 17 months. Eleven patients had coronary events (CE) during this period: 1 case of nonfatal myocardial infarction and 10 cases of unstable angina. A strong correlation between CBFI and BBFI was observed at middle-and high-doses of ACh (r=0.72, p<0.0001, 15 microg/min vs 10(-7) mol/L; r=0.76, p<0.0001, 30 microg/min vs 10(-6) mol/L). Kaplan-Meier analysis, using the best cut-off values obtained from receiver-operating characteristic curves for CE, revealed that both CBFI and CAFI were significant predictors for CE.
The BA vasodilator response to optimal ACh dosage can be used as a surrogate prognostic predictor for coronary endothelial function tests in patients with suspected CAD.
在有冠心病危险因素和冠状动脉疾病（CAD）的患者中，对乙酰胆碱（ACh）的血管舒张反应（即内皮依赖性舒张）在周围循环和冠状动脉循环中受损。冠状动脉（CA）和肱动脉（BA）对ACh的血管舒张反应密切相关，但在相对低风险的疑似CAD患者中，这些反应的比较预后重要性尚未得到充分研究。
在70例疑似CAD患者中测量了CA和BA的血流反应，排除了三支血管病变以及已知周围血管或脑血管疾病的患者。将多普勒导丝置入CA的一个主要分支和左BA的近端。分别以10(-8)、10(-7)和10(-6)mol/L的浓度向CA内注入ACh 3分钟，以7.5、15和30μg/min的速度向BA内注入ACh 5分钟。通过将定量血管造影得到的平均峰值速度乘以横截面积来获得血流反应。通过ACh诱导的血流/基础血流的比值评估对ACh的血管舒张反应，以冠状动脉血流指数（CBFI）或肱动脉血流指数（BBFI）表示。有39例CAD患者（61±8岁）和31例冠状动脉正常患者（NL，58±11岁），随访53±17个月。在此期间有11例患者发生冠状动脉事件（CE）：1例非致命性心肌梗死和10例不稳定型心绞痛。在中高剂量ACh时观察到CBFI和BBFI之间有很强的相关性（r = 0.72，p < 0.0001，15μg/min对10(-7)mol/L；r = 0.76，p < 0.0001，30μg/min对10(-6)mol/L）。采用从CE的受试者操作特征曲线获得的最佳截断值进行Kaplan-Meier分析，结果显示CBFI和CAFI都是CE的显著预测指标。
最佳ACh剂量下的BA血管舒张反应可作为疑似CAD患者冠状动脉内皮功能测试的替代预后预测指标。
Zotero 插件