Division of Cardiology, Department of Internal Medicine College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Clin Cardiol. 2012 Feb;35(2):119-24. doi: 10.1002/clc.20980. Epub 2011 Nov 18.
Several studies demonstrated that endothelial or atherosclerotic biomarkers, including plasma free insulin-like growth factor-I(IGF-I), soluble CD40 ligand (sCD40L), adiponectin, and leptin have an influence on coronary endothelial function.
The aim of the present study was to investigate whether change of coronary flow velocity of the distal left anterior descending artery (LAD) during the cold pressor test (CPT) with transthoracic Doppler echocardiography (TTE) was associated with these biomarkers in subjects with chest pain and a normal coronary angiogram.
In 190 subjects (mean age, 54±11 years; male:female, 113:77) with chest pain and a normal coronary angiogram, peak diastolic velocity (PDV) of the distal LAD during the CPT with TTE was assessed. Acetylcholine provocation test was performed in 58 subjects (mean age, 51±10 years) who were clinically suspected of vasospasm. CPT%PDV was defined as the percent change in PDV during the CPT. Associations between CPT%PDV and clinical parameters were analyzed.
According to multiple regression analysis, CPT%PDV was associated with plasma free IGF-I in the entire study population (β=0.295, P<0.001 in all subjects; β=0.341, P=0.001 in males; β=0.243, P=0.037 in females; β=0.303, P=0.002 in nonsmokers; and β=0.256, P=0.047 in smokers), and sCD40L in males (β=-0.269, P=0.008)and smokers (β=-0.261, P=0.046). Subjects with vasospasm to intracoronary acetylcholine had lower plasma free IGF-I(6.9±3.3 vs 8.9±3.4, P=0.026) and CPT%PDV (8.8±24.9 vs 52.7±26.0, P<0.001) than the others. Plasma adiponectin and leptin were not associated with CPT%PDV.
Change of coronary flow velocity assessed using the CPT with TTE may be related to endothelial markers, especially plasma free IGF-I.
多项研究表明，内皮或动脉粥样硬化生物标志物，包括血浆游离胰岛素样生长因子-I（IGF-I）、可溶性 CD40 配体（sCD40L）、脂联素和瘦素，对冠状动脉内皮功能有影响。
本研究旨在探讨经胸超声心动图（TTE）检测冷加压试验（CPT）中左前降支远段冠状动脉血流速度的变化是否与胸痛且冠状动脉造影正常的患者的这些生物标志物相关。
在 190 名胸痛且冠状动脉造影正常的患者（平均年龄 54±11 岁；男：女，113:77）中，使用 TTE 评估 CPT 时左前降支远段的最大舒张末期速度（PDV）。对 58 名临床怀疑存在血管痉挛的患者（平均年龄 51±10 岁）进行乙酰胆碱激发试验。CPT%PDV 定义为 CPT 期间 PDV 的百分比变化。分析 CPT%PDV 与临床参数之间的关系。
根据多元回归分析，CPT%PDV 与整个研究人群中的血浆游离 IGF-I 相关（所有受试者：β=0.295，P<0.001；男性：β=0.341，P=0.001；女性：β=0.243，P=0.037；不吸烟者：β=0.303，P=0.002；吸烟者：β=0.256，P=0.047），与男性（β=-0.269，P=0.008）和吸烟者（β=-0.261，P=0.046）中的 sCD40L 相关。对冠状动脉内乙酰胆碱有血管痉挛反应的患者的血浆游离 IGF-I（6.9±3.3 比 8.9±3.4，P=0.026）和 CPT%PDV（8.8±24.9 比 52.7±26.0，P<0.001）均较低。血浆脂联素和瘦素与 CPT%PDV 无关。
使用 TTE 进行 CPT 评估的冠状动脉血流速度变化可能与内皮标志物相关，尤其是血浆游离 IGF-I。
