Venneri Lucia, Poggianti Elisa, Jambrik Zoltan, Varga Albert, Palinkas Attila, Picano Eugenio
Int J Cardiol. 2007 Jun 25;119(1):109-11. doi: 10.1016/j.ijcard.2006.07.069. Epub 2006 Oct 12.
The prognostic value of systemic endothelial dysfunction still remains uncertain in ischemic heart disease. The aim of the study was to establish the prognostic value of ultrasonically assessed systemic endothelial dysfunction in patients with chest pain syndrome and to assess whether this information was incremental to that already provided by simple parameters derived from echocardiography, such as left ventricular mass index or ejection fraction. One hundred ninety-five in-hospital patients (age=60+/-10 years; 63 females) with known or suspected CAD have been enrolled. All of the patients underwent, on different days, coronary angiography, endothelium-dependent FMD testing of the brachial artery by high-resolution ultrasound and resting 2D-echocardiography evaluation. The result of the FMD has been defined as the percent change in the internal diameter of the brachial artery during reactive hyperemia related to baseline. All patients were followed-up for a median of 27 months. During follow-up there were 17 deaths (9 cardiac), 4 non-fatal myocardial infarction (MI), and 18 late clinically-driven revascularization procedures. By a multivariate analysis, echocardiographically assessed ejection fraction (odds ratio: 2.32; 95% confidence interval: 1.24-4.33; p=0.008) and angiographically assessed CAD (odds ratio: 2.82; 95% confidence interval: 1.40-5.67; p=0.003), were independent prognostic predictors of events. In patients with known or suspected CAD, systemic endothelial dysfunction did not show a significant prognostic value. Echocardiographic indices of structural left ventricular damage appear to have a stronger prognostic value than functional indices of peripheral vascular damage in risk stratifying ischemic patients.
在缺血性心脏病中，系统性内皮功能障碍的预后价值仍不确定。本研究的目的是确定超声评估的系统性内皮功能障碍在胸痛综合征患者中的预后价值，并评估该信息是否对已由超声心动图得出的简单参数（如左心室质量指数或射血分数）所提供的信息具有增量作用。195名已知或疑似患有冠心病的住院患者（年龄=60±10岁；63名女性）被纳入研究。所有患者在不同日期接受了冠状动脉造影、通过高分辨率超声对肱动脉进行的内皮依赖性血流介导的血管舒张功能（FMD）检测以及静息二维超声心动图评估。FMD的结果被定义为反应性充血期间肱动脉内径相对于基线的变化百分比。所有患者的中位随访时间为27个月。随访期间有17例死亡（9例心脏相关）、4例非致命性心肌梗死（MI）和18例后期临床驱动的血运重建手术。通过多变量分析，超声心动图评估的射血分数（比值比：2.32；95%置信区间：1.24 - 4.33；p = 0.008）和冠状动脉造影评估的冠心病（比值比：2.82；95%置信区间：1.40 - 5.67；p = 0.003）是事件的独立预后预测因素。在已知或疑似患有冠心病的患者中，系统性内皮功能障碍未显示出显著的预后价值。在对缺血性患者进行风险分层时，左心室结构损伤的超声心动图指标似乎比外周血管损伤的功能指标具有更强的预后价值。
