女性内皮功能与缺血性心脏病的数字评估。

Digital assessment of endothelial function and ischemic heart disease in women.

机构信息

Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.

出版信息

J Am Coll Cardiol. 2010 Apr 20;55(16):1688-96. doi: 10.1016/j.jacc.2009.10.073.

DOI:10.1016/j.jacc.2009.10.073

PMID:20394872

Abstract

OBJECTIVES

We investigated the utility of digital reactive hyperemia peripheral arterial tonometry (RH-PAT) in predicting ischemic heart disease (IHD), including obstructive coronary artery disease (CAD) and nonobstructive coronary artery disease (NOCAD), in women.

BACKGROUND

IHD is the leading cause of mortality, and its pathogenesis is diverse in women. Fingertip RH-PAT is a new device that provides noninvasive, automatic, and quantitative evaluation of endothelial dysfunction.

METHODS

RH-PAT was measured using Endo-PAT2000 (Itamar Medical, Caesarea, Israel) before cardiac catheterization in 140 stable women scheduled for hospitalization to examine chest pain. NOCAD was diagnosed by angiography with measurement of coronary blood flow and cardiac lactate production during intracoronary acetylcholine provocation test and cardiac scintigraphy with stress tests.

RESULTS

Sixty-eight women (49%) had obstructive CAD and 42 women (30%) had NOCAD. RH-PAT indexes were significantly attenuated in both obstructive CAD and NOCAD as compared with non-IHD (n = 30) (obstructive CAD: median 1.57, interquartile range [IQR] 1.42 to 1.76; NOCAD: median 1.58, IQR 1.41 to 1.78; non-IHD: median 2.15, IQR 1.85 to 2.48, p < 0.001). By multivariate logistic regression analysis, only RH-PAT index was significantly associated with IHD, including obstructive CAD and NOCAD (odds ratio 0.51; 95% confidence interval: 0.38 to 0.68; p < 0.001). In receiver-operating characteristic analysis, RH-PAT index was a significant predictor of IHD (area under the curve 0.86; p < 0.001). Furthermore, only RH-PAT was useful for the prediction of NOCAD after excluding obstructive CAD (area under the curve 0.85; p < 0.001; RH-PAT index of <1.82 had 81% sensitivity and 80% specificity).

CONCLUSIONS

RH-PAT indexes were significantly attenuated in women with IHD. Digital RH-PAT can predict patients with IHD, especially NOCAD before angiography. RH-PAT is potentially useful for identifying high-risk women for IHD. (Endothelial Dysfunction and Coronary Artery Spasm; NCT00619294).

摘要

目的

我们旨在研究数字反应性充血外周动脉张力测定（RH-PAT）在预测女性缺血性心脏病（IHD）中的作用，包括阻塞性冠状动脉疾病（CAD）和非阻塞性冠状动脉疾病（NOCAD）。

背景

IHD 是女性死亡的主要原因，其发病机制多种多样。指尖 RH-PAT 是一种新的设备，可以提供内皮功能障碍的无创、自动和定量评估。

方法

在 140 名因胸痛拟住院行心脏导管检查的稳定女性中，使用 Endo-PAT2000（以色列凯撒利亚的 Itamar Medical）在心脏导管检查前测量 RH-PAT。通过冠状动脉造影和乙酰胆碱激发试验时冠状动脉血流和心肌乳酸生成的测量以及应激试验时心肌闪烁照相术诊断 NOCAD。

结果

68 名女性（49%）患有阻塞性 CAD，42 名女性（30%）患有 NOCAD。与非 IHD（n=30）相比，阻塞性 CAD 和 NOCAD 的 RH-PAT 指数明显降低（阻塞性 CAD：中位数 1.57，四分位距 [IQR] 1.42 至 1.76；NOCAD：中位数 1.58，IQR 1.41 至 1.78；非 IHD：中位数 2.15，IQR 1.85 至 2.48，p<0.001）。通过多元逻辑回归分析，只有 RH-PAT 指数与 IHD 显著相关，包括阻塞性 CAD 和 NOCAD（比值比 0.51；95%置信区间：0.38 至 0.68；p<0.001）。在接受者操作特征分析中，RH-PAT 指数是 IHD 的一个显著预测因子（曲线下面积 0.86；p<0.001）。此外，在排除阻塞性 CAD 后，只有 RH-PAT 对 NOCAD 的预测才有意义（曲线下面积 0.85；p<0.001；<1.82 的 RH-PAT 指数有 81%的敏感性和 80%的特异性）。