Iino Kenji, Watanabe Hiroyuki, Iino Takako, Katsuta Mitsuaki, Koyama Takashi, Kosaka Toshimitsu, Terui Gen, Ito Hiroshi
Department of Cardiovascular and Respiratory Medicine, Akita University Graduate School of Medicine, Hondoh, Japan.
Coron Artery Dis. 2012 Jun;23(4):278-83. doi: 10.1097/MCA.0b013e328351ab42.
Endothelial dysfunction is closely related to cardiovascular events. Several studies have documented that angiotensin II type 1 receptor blockers (ARB) improve peripheral endothelial dysfunction. However, the effect of ARB on coronary endothelial function remains elusive. The purpose of this study was to ascertain the beneficial effects of ARB on human coronary artery endothelial function.
Twenty-seven patients were randomly assigned to either the candesartan group (n=14) or the control group (n=13) and followed for 12 months. Coronary blood flow velocity was measured in the left anterior descending artery without stenosis using an intracoronary Doppler-tipped guide-wire. We evaluated coronary endothelial function as the coronary blood flow velocity reserve (CFR), which was defined as the percent change in the coronary blood flow velocity after an intracoronary acetylcholine infusion. At baseline, the CFR in both groups was below 300%, implying that these patients had endothelial dysfunction. After treatment with candesartan for 6 months, the CFR increased significantly from 199 ± 20 to 337 ± 27% (P<0.001), whereas the CFR did not change in the control group (194 ± 32 vs. 185 ± 41%, P=0.52). During 12 months of observation, the cardiovascular event-free survival rate of the patients with an increased CFR was significantly greater than the rate in patients with a decreased CFR (P=0.02). Moreover, the cardiovascular event-free survival rate was greater in the candesartan group than in the control group (P=0.04).
Our results suggest that candesartan improves coronary endothelial dysfunction of human coronary arteries and may prevent cardiac events.
内皮功能障碍与心血管事件密切相关。多项研究表明，血管紧张素II 1型受体阻滞剂（ARB）可改善外周内皮功能障碍。然而，ARB对冠状动脉内皮功能的影响仍不明确。本研究的目的是确定ARB对人冠状动脉内皮功能的有益作用。
27例患者被随机分为坎地沙坦组（n = 14）或对照组（n = 13），随访12个月。使用冠状动脉内多普勒探头导丝测量无狭窄的左前降支冠状动脉血流速度。我们将冠状动脉内皮功能评估为冠状动脉血流速度储备（CFR），其定义为冠状动脉内注入乙酰胆碱后冠状动脉血流速度的变化百分比。基线时，两组的CFR均低于300%，这意味着这些患者存在内皮功能障碍。用坎地沙坦治疗6个月后，CFR从199±20显著增加至337±27%（P<0.001），而对照组的CFR没有变化（194±32 vs. 185±41%，P = 0.52）。在12个月的观察期内，CFR增加的患者的无心血管事件生存率显著高于CFR降低的患者（P = 0.02）。此外，坎地沙坦组的无心血管事件生存率高于对照组（P = 0.04）。
我们的结果表明，坎地沙坦可改善人冠状动脉的内皮功能障碍，并可能预防心脏事件。
