健康受试者和冠心病患者冠状动脉内皮功能的无创可视化。
Noninvasive visualization of coronary artery endothelial function in healthy subjects and in patients with coronary artery disease.
机构信息
Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA.
出版信息
J Am Coll Cardiol. 2010 Nov 9;56(20):1657-65. doi: 10.1016/j.jacc.2010.06.036.
OBJECTIVES
The goal was to test 2 hypotheses: first, that coronary endothelial function can be measured noninvasively and abnormal function detected using clinical 3.0-T magnetic resonance imaging (MRI); and second, that the extent of local coronary artery disease (CAD), in a given patient, is related to the degree of local abnormal coronary endothelial function.
BACKGROUND
Abnormal endothelial function mediates the initiation and progression of atherosclerosis and predicts cardiovascular events. However, direct measures of coronary endothelial function have required invasive assessment.
METHODS
The MRI was performed in 20 healthy adults and 17 patients with CAD. Cross-sectional coronary area and blood flow were quantified before and during isometric handgrip exercise, an endothelial-dependent stressor. In 10 severe, single-vessel CAD patients, paired endothelial function was measured in the artery with severe stenosis and the contralateral artery with minimal disease.
RESULTS
In healthy adults, coronary arteries dilated and flow increased with stress. In CAD patients, coronary artery area and blood flow decreased with stress (both p ≤ 0.02). In the paired study, coronary artery area and blood flow failed to increase during exercise in the mildly diseased vessel, but both area (p = 0.01) and blood flow (p = 0.02) decreased significantly in the severely diseased, contralateral artery.
CONCLUSIONS
Endothelial-dependent coronary artery dilation and increased blood flow in healthy subjects, and their absence in CAD patients, can now be directly visualized and quantified noninvasively. Local coronary endothelial function differs between severely and mildly diseased arteries in a given CAD patient. This novel, safe method may offer new insights regarding the importance of local coronary endothelial function and improved risk stratification in patients at risk for and with known CAD.
目的
旨在检验 2 个假设：首先，冠状动脉内皮功能可通过临床 3.0-T 磁共振成像（MRI）进行无创检测，且功能异常可被检出；其次，在给定患者中，局部冠状动脉疾病（CAD）的严重程度与局部异常冠状动脉内皮功能的严重程度相关。
背景
内皮功能异常介导动脉粥样硬化的发生和进展，并可预测心血管事件。然而，对冠状动脉内皮功能的直接测量需要进行有创评估。
方法
本研究纳入 20 名健康成年人和 17 名 CAD 患者，在进行等长握力运动（一种内皮依赖性应激源）前后对冠状动脉的横截面积和血流量进行了定量评估。在 10 例严重单支 CAD 患者中，对严重狭窄动脉和对侧最小病变动脉进行了配对内皮功能测量。
结果
在健康成年人中，冠状动脉在应激时扩张，血流量增加。在 CAD 患者中，冠状动脉面积和血流量在应激时减少（均 p ≤ 0.02）。在配对研究中，在轻度病变血管中，运动期间冠状动脉面积和血流量未能增加，但在严重病变的对侧动脉中，两者均明显减少（面积：p = 0.01；血流量：p = 0.02）。
结论
在健康受试者中，内皮依赖性冠状动脉扩张和血流量增加，而在 CAD 患者中则不存在这种情况，现在可以直接可视化和定量无创检测到。在给定 CAD 患者中，严重和轻度病变的动脉之间局部冠状动脉内皮功能存在差异。这种新颖、安全的方法可能为局部冠状动脉内皮功能的重要性以及对高危和已知 CAD 患者的风险分层提供新的见解。
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