Nemes Attila, Forster Tamás, Geleijnse Marcel L, Soliman Osama I I, Ten Cate Folkert J, Csanády Miklós
2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Medical and Pharmaceutical Centre, University of Szeged, Korányi fasor 6, P.O. Box 427, H-6720 Szeged, Hungary.
Heart Vessels. 2008 May;23(3):167-73. doi: 10.1007/s00380-007-1026-5. Epub 2008 May 17.
In recent studies it has been demonstrated that a reduced coronary flow reserve (CFR) is independently associated with a less benign long-term outcome. Aortic stiffness is one of the most important cardiovascular risk factors predicting cardiovascular morbidity and mortality. Vasodilator stress transesophageal echocardiography (TEE) is a suitable method to evaluate simultaneously CFR and elastic properties of the descending thoracic aorta. The aim of the present study was to assess the relative prognostic value of simultaneously measured CFR and aortic elastic properties by pulsed-wave Doppler TEE in patients with suspected or known coronary artery disease (CAD). The study comprised 157 in-hospital patients with chest pain. In all patients, stress TEE was used for the simultaneous evaluation of CFR and aortic distensibility indices [elastic modulus E(p) and Young's circumferential static elastic modulus E(s)]. During a mean follow-up of 48 +/- 8 months, 13 patients suffered cardiovascular death. By univariate analysis older age, diabetes mellitus, increased left ventricular (LV) end-diastolic diameter, increased LV mass index, lower LV ejection fraction, and lower CFR were significant predictors of cardiovascular survival. Multivariate regression analysis showed that only CFR (hazard ratio [HR] 10.31, P = 0.04), age (HR 1.20, P = 0.001), and increased left ventricular (LV) end-diastolic diameter (HR 1.14, P = 0.02) were independent predictors of cardiovascular survival. Only in the small number of patients without CAD and abnormal CFR aortic distensibility seemed to provide complementary prognostic information over CFR. In the majority of patients aortic distensibility did not offer complementary prognostic information to CFR during vasodilator stress TEE testing.
最近的研究表明，冠状动脉血流储备（CFR）降低与不良的长期预后独立相关。主动脉僵硬度是预测心血管疾病发病率和死亡率的最重要心血管危险因素之一。血管扩张剂负荷经食管超声心动图（TEE）是一种同时评估CFR和胸降主动脉弹性特性的合适方法。本研究的目的是评估通过脉冲波多普勒TEE同时测量的CFR和主动脉弹性特性在疑似或已知冠状动脉疾病（CAD）患者中的相对预后价值。该研究纳入了157例住院胸痛患者。对所有患者均采用负荷TEE同时评估CFR和主动脉扩张性指标[弹性模量E(p)和杨氏圆周静态弹性模量E(s)]。在平均48±8个月的随访期间，13例患者发生心血管死亡。单因素分析显示，年龄较大、糖尿病、左心室（LV）舒张末期直径增加、LV质量指数增加、LV射血分数降低和CFR降低是心血管生存的重要预测因素。多因素回归分析显示，只有CFR（风险比[HR]10.31，P = 0.04）、年龄（HR 1.20，P = 0.001）和左心室（LV）舒张末期直径增加（HR 1.14，P = 0.02）是心血管生存的独立预测因素。只有在少数无CAD且CFR异常的患者中，主动脉扩张性似乎比CFR提供了补充的预后信息。在大多数患者中，在血管扩张剂负荷TEE检查期间，主动脉扩张性并未为CFR提供补充的预后信息。
