Laiko General Hospital, First Surgical Department, Vascular Division, University of Athens Medical School, Athens, Greece.
J Vasc Surg. 2011 Jul;54(1):93-9. doi: 10.1016/j.jvs.2010.11.121. Epub 2011 Mar 31.
The baroreflex sensitivity is impaired in patients with carotid atherosclerosis. The purpose of our study was to assess the impact of carotid plaque echogenicity on the baroreflex function in patients with significant carotid atherosclerosis, who have not undergone carotid surgery.
Spontaneous baroreflex sensitivity (sBRS) was estimated in 45 patients with at least a severe carotid stenosis (70%-99%). sBRS calculation was performed noninvasively, with the spontaneous sequence method, based on indirectly estimated central blood pressures from radial recordings. This method failed in three patients due to poor-quality recordings, and eventually 42 patients were evaluated. After carotid duplex examination, carotid plaque echogenicity was graded from 1 to 4 according to Gray-Weale classification and the patients were divided into two groups: the echolucent group (grades 1 and 2) and the echogenic group (grades 3 and 4).
Sixteen patients (38%) and 26 patients (62%) were included in the echolucent and echogenic group, respectively. Diabetes mellitus was observed more frequently among echolucent plaques (χ(2) = 8.0; P < .004), while those plaques were also more commonly symptomatic compared with echogenic atheromas (χ(2) = 8.5; P < .003). Systolic arterial pressure, diastolic arterial pressure, and heart rate were similar in the two groups. Nevertheless, the mean value of baroreflex sensitivity was found to be significantly lower in the echogenic group (2.96 ms/mm Hg) compared with the echolucent one (5.0 ms/mm Hg), (F [1, 42] = 10.1; P < .003).
These findings suggest that echogenic plaques are associated with reduced baroreflex function compared with echolucent ones. Further investigation is warranted to define whether such an sBRS impairment could be responsible for cardiovascular morbidity associated with echogenic plaques.
颈动脉粥样硬化患者的压力感受性反射敏感性受损。本研究的目的是评估颈动脉斑块回声特征对未经颈动脉手术的严重颈动脉粥样硬化患者压力感受性反射功能的影响。
对 45 例至少存在严重颈动脉狭窄（70%-99%）的患者进行自发性压力感受性反射敏感性（sBRS）估计。sBRS 的计算采用非侵入性的、基于间接估计的源自桡动脉记录的中心血压的自发性序列方法。由于记录质量差，该方法在 3 例患者中失败，最终评估了 42 例患者。在颈动脉双功能超声检查后，根据 Gray-Weale 分类对颈动脉斑块回声进行分级，从 1 级到 4 级，将患者分为两组：低回声组（1 级和 2 级）和高回声组（3 级和 4 级）。
16 例（38%）和 26 例（62%）患者分别纳入低回声组和高回声组。低回声斑块更常伴有糖尿病（χ(2) = 8.0；P <.004），而与高回声动脉粥样硬化斑块相比，这些斑块更常伴有症状（χ(2) = 8.5；P <.003）。两组的收缩压、舒张压和心率相似。然而，高回声组的平均压力感受性反射敏感性（2.96 ms/mm Hg）显著低于低回声组（5.0 ms/mm Hg）（F [1, 42] = 10.1；P <.003）。
这些发现表明，与低回声斑块相比，高回声斑块与压力感受性反射功能降低有关。需要进一步研究以确定这种 sBRS 损害是否是与高回声斑块相关的心血管发病率的原因。
