Kalay Nihat, Yarlioglues Mikail, Ardic Idris, Duran Mustafa, Kaya Mehmet Gungor, Inanc Tugrul, Dogan Ali, Koç Fatih, Ciçek Davran, Kasapkara Ahmet, Celik Ahmet, Topsakal Ramazan, Oguzhan Abdurrahman, Ergin Ali
Department of Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey.
Clin Invest Med. 2010 Feb 1;33(1):E36-43. doi: 10.25011/cim.v33i1.11836.
Endothelial dysfunction plays a crucial role in the process of atherosclerotic diseases and has been accepted as an early stage of atherosclerosis. Carotid intima-media-thickness (CIMT) and flow-mediated-dilatation (FMD) of the brachial artery have been recommended as noninvasive methods to assess endothelial structure and function. Angiographic properties of patients with acute coronary syndrome (ACS) are closely associated with cardiovascular events. In this study, we investigated the relation of atherosclerotic properties of coronary, brachial and carotid arteries with CIMT, FMD and coronary angiography in patients with ACS.
We enrolled 133 patients who were diagnosed with ACS into this study. Exclusion criteria were known coronary artery disease, diabetes mellitus and hypertension. Coronary angiography, CIMT and FMD were measured in all patients. The numbers of major stenotic coronary vessels with > or = 50% or > or = 70% were defined as diseased vessel. Gensini score was used to evaluate the severity of atherosclerosis. Morphologic properties of stenotic lesion were defined. Cutoff levels were 7% for FMD and 0.9 mm for CIMT.
Mean age was 59.7 + or - 11.8 years. FMD, CIMT and Gensini score were 8.3 + or - 5.9%, 0.80 + or - 0.19 mm and 7.8 + or - 3.5, respectively. Only 44% of patients with ACS had impaired FMD. Gensini score, number of diseased vessels and number of critical lesions were higher in patients with impaired FMD. (Gensini: 8.7 + or - 3.6 vs. 7.0 + or - 3.1, p = 0.009, diseased vessels: 2.7 + or - 0.4 vs. 2.3 + or - 0.7, p < 0.0001, critical lesions: 3.0 + or - 2.1 vs. 2.2 + or - 1.4, p = 0.02). Increased CIMT was found in only 33% of patients. Gensini score and number of diseased vessels were significantly higher in patients with increased CIMT. Significant but weak correlations were found between CIMT, FMD and angiographic severity of coronary atherosclerosis. Angiographic properties and lesion morphology were similar between CIMT and FMD groups.
There appears to be a relationship between CIMT, FMD and severity of coronary atherosclerosis in patients with ACS. However, in patients with ACS, morphologic properties of stenotic lesions are not associated with CIMT and FMD in brachial artery.
内皮功能障碍在动脉粥样硬化疾病的发生过程中起着关键作用，并且已被公认为是动脉粥样硬化的早期阶段。肱动脉的颈动脉内膜中层厚度（CIMT）和血流介导的血管舒张（FMD）已被推荐作为评估内皮结构和功能的无创方法。急性冠状动脉综合征（ACS）患者的血管造影特征与心血管事件密切相关。在本研究中，我们调查了ACS患者冠状动脉、肱动脉和颈动脉的动脉粥样硬化特征与CIMT、FMD及冠状动脉造影之间的关系。
我们招募了133例被诊断为ACS的患者纳入本研究。排除标准为已知的冠状动脉疾病、糖尿病和高血压。对所有患者进行冠状动脉造影、CIMT和FMD测量。将主要狭窄冠状动脉血管数量≥50%或≥70%定义为病变血管。使用Gensini评分评估动脉粥样硬化的严重程度。定义狭窄病变的形态学特征。FMD的截断水平为7%，CIMT的截断水平为0.9mm。
平均年龄为59.7±11.8岁。FMD、CIMT和Gensini评分分别为8.3±5.9%、0.80±0.19mm和7.8±3.5。只有44%的ACS患者FMD受损。FMD受损患者的Gensini评分、病变血管数量和严重病变数量更高。（Gensini评分：8.7±3.6对7.0±3.1，p=0.009；病变血管数量：2.7±0.4对2.3±0.7，p<0.0001；严重病变数量：3.0±2.1对2.2±1.4，p=0.02）。仅33%的患者CIMT增加。CIMT增加的患者Gensini评分和病变血管数量显著更高。CIMT、FMD与冠状动脉粥样硬化的血管造影严重程度之间存在显著但较弱的相关性。CIMT和FMD组之间的血管造影特征和病变形态相似。
ACS患者的CIMT、FMD与冠状动脉粥样硬化的严重程度之间似乎存在关联。然而，在ACS患者中，狭窄病变的形态学特征与肱动脉的CIMT和FMD无关。
