Department of Cardiology, Medical University of Silesia, Katowice, Poland.
Int J Cardiol. 2012 Jul 26;158(3):364-9. doi: 10.1016/j.ijcard.2011.01.037. Epub 2011 Feb 18.
Cardiovascular events are the main cause of premature death after successful repair of aortic coarctation (CoA). The aim of this study was to assess the selected biochemical markers of atherosclerosis in normotensive CoA repaired patients and to establish its relation to ultrasound indexes of vascular pathology.
62 patients after CoA repair (37 males, age: 34.1 ± 1.4 yrs) and 20 control individuals (10 males, age: 34.8 ± 2.2 yrs) were enrolled in the study. The serum markers: asymmetric dimethylarginine (ADMA), nitrites/nitrates (NOx), high-sensitivity C-reactive protein (hsCRP), and following vascular parameters: flow-mediated dilatation (FMD), intima-media thickness (IMT) and pulse wave velocity (PWV) were analyzed.
33 CoA repaired patients were normotensive, and compared to controls, they presented higher serum ADMA concentrations (0.59 ± 0.04 umol/l vs. 0.46 ± 0.03 umol/l, p=0.035). An analysis of the vascular parameters revealed decreased FMD (4.75 ± 0.5%), NMD (11.86 ± 0.8%) and increased PWV (6.90 ± 0.2 m/s) values in the normotensive patients as compared with the control group (FMD: 8.6 ± 0.9%, p<0.001, NMD: 20.94 ± 1.7%, p<0.001; PWV: 5.49 ± 0.2, p=0.023). There were no differences in the serum levels of NOx, hsCRP as well as IMT values between normotensive patients and the control group. A multivariate regression analysis revealed that serum ADMA level was a factor independently associated with the FMD value (r=-0.334; p=0.031) in normotensive CoA repaired group.
Early biochemical and vascular indices of atherosclerosis such as increased serum ADMA concentration as well as impaired vasodilatation and increased arterial stiffness are observed in patients after CoA repair. Serum ADMA is a strong predictor of endothelial dysfunction in patients with CoA repair.
心血管事件是主动脉缩窄（CoA）修复成功后导致过早死亡的主要原因。本研究旨在评估血压正常的 CoA 修复患者的动脉粥样硬化的选定生化标志物，并确定其与血管病变的超声指标的关系。
研究纳入了 62 例 CoA 修复后的患者（37 名男性，年龄：34.1±1.4 岁）和 20 名对照个体（10 名男性，年龄：34.8±2.2 岁）。分析了血清标志物：不对称二甲基精氨酸（ADMA）、亚硝酸盐/硝酸盐（NOx）、高敏 C 反应蛋白（hsCRP）以及以下血管参数：血流介导的扩张（FMD）、内膜-中层厚度（IMT）和脉搏波速度（PWV）。
33 例 CoA 修复后的患者血压正常，与对照组相比，他们的血清 ADMA 浓度较高（0.59±0.04 umol/l 比 0.46±0.03 umol/l，p=0.035）。血管参数分析显示，与对照组相比，血压正常的患者的 FMD（4.75±0.5%）、NMD（11.86±0.8%）降低，而 PWV（6.90±0.2 m/s）升高（FMD：8.6±0.9%，p<0.001，NMD：20.94±1.7%，p<0.001；PWV：5.49±0.2，p=0.023）。血压正常的患者与对照组之间血清 NOx、hsCRP 水平和 IMT 值无差异。多变量回归分析显示，血清 ADMA 水平是血压正常的 CoA 修复组 FMD 值的独立相关因素（r=-0.334；p=0.031）。
在 CoA 修复后，患者会出现早期的动脉粥样硬化生化和血管指数，如血清 ADMA 浓度升高、血管舒张功能受损和动脉僵硬度增加。血清 ADMA 是 CoA 修复患者内皮功能障碍的一个有力预测指标。
