Division of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland.
Clin Cardiol. 2010 Dec;33(12):746-52. doi: 10.1002/clc.20836.
Endothelial dysfunction (ED) is frequently present in patients presenting with acute or stable coronary artery disease (CAD), but it is also found in patients presenting with chest pain without angiographic coronary lesions.
We hypothesized that even in patients without CAD, the presence of cardiovascular (CV) risk factors will correlate with the presence of ED.
Our study included a total of 341 consecutive patients referred for coronary angiography. We used pulse wave analysis with a finger plethysmograph (peripheral arterial tonometry) to determine endothelial function. Hyperemia ratio was calculated as the ratio of the postischemic hyperemia response relative to baseline measurement.
The hyperemia ratio was significantly higher in patients without CAD (2.02 ± 0.52) compared with patients with chronic CAD (1.81 ± 0.44, P = 0.001) or acute CAD (1.74 ± 0.49, P < 0.001). Prevalence of ED was 33%, 46%, and 58%, respectively. In multivariate analysis, the presence of CAD, diabetes, and cigarette smoking, and the total number of CV risk factors, were strong predictors of ED. In 67% of the patients without CAD but with ≥3 CV risk factors, ED was present.
Prevalence of ED in patients with chest pain depends on the presence of CAD and CV risk factors. Patients without CAD but with ≥3 risk factors frequently presented with ED. Such patients may be at increased risk for future CV events and may profit from intensified therapy to control CV risk factors.
内皮功能障碍（ED）在患有急性或稳定型冠状动脉疾病（CAD）的患者中经常出现，但在没有冠状动脉造影病变的胸痛患者中也存在。
我们假设即使在没有 CAD 的患者中，心血管（CV）危险因素的存在也与 ED 的存在相关。
我们的研究共纳入 341 例连续因冠状动脉造影而就诊的患者。我们使用手指体积描记法（外周动脉张力测定法）进行脉搏波分析，以确定内皮功能。通过计算缺血后充血反应与基线测量值的比值来确定充血比。
无 CAD 患者的充血比明显高于慢性 CAD 患者（2.02±0.52 比 1.81±0.44，P=0.001）或急性 CAD 患者（1.74±0.49，P<0.001）。ED 的患病率分别为 33%、46%和 58%。在多变量分析中，CAD、糖尿病和吸烟的存在以及 CV 危险因素的总数是 ED 的强烈预测因素。在无 CAD 但有≥3 个 CV 危险因素的 67%患者中，存在 ED。
胸痛患者中 ED 的患病率取决于 CAD 和 CV 危险因素的存在。无 CAD 但有≥3 个危险因素的患者常伴有 ED。这些患者可能有更高的未来 CV 事件风险，并可能受益于强化治疗以控制 CV 危险因素。
