Clinical Trials & Evaluation Unit, Royal Brompton Hospital & National Heart & Lung Institute, Imperial College London, United Kingdom.
Int J Cardiol. 2013 Aug 10;167(3):917-24. doi: 10.1016/j.ijcard.2012.03.098. Epub 2012 Apr 4.
Angiographically-normal coronary arteries are reported in 10-20% of patients undergoing diagnostic coronary angiography despite screening with risk factors and functional tests. We sought to validate and determine the clinical value of radial artery pulse wave analysis (PWA), a simple, quick and non-invasive marker of central artery stiffness and define its ability to predict coronary artery disease in high-risk patients.
531 consecutive patients referred for elective coronary angiography, irrespective of previous co-morbidity, were assessed in a prospective, multicenter observational study [the Alternative Risk Markers in Coronary Artery Disease (ARM-CAD) study].
Mean age was 65 ± 11 years, 33% were women, 18% had impaired left-ventricular function and 22% a prior myocardial infarction. Angiography demonstrated normal coronary arteries in 20% of participants. The only independent associations with this outcome were younger age, female gender, absence of diabetes and PWA-derived central augmentation pressure <24 mm Hg. The odds ratio for the latter after adjustment for medications and baseline risk factors (including blood pressure, high-sensitivity C-reactive protein and B-type natriuretic peptide) was 3.4 (95% CI 1.2 to 9.5; p=0.021). The specificity for the multivariate model that included PWA was 95.7% with a receiver operator curve area of 0.876. Validation studies suggested that systolic variables from PWA were robust regardless of waveform quality and similar to measured aortic pressures (mean difference 2.7 mm Hg).
Assessment of radial artery waveforms is a useful non-invasive clinical test that can stratify the likelihood of coronary disease and assist in identifying patients who require diagnostic angiography.
尽管通过危险因素和功能测试进行了筛查，但在接受诊断性冠状动脉造影的患者中，仍有 10-20%报告存在血管造影正常的冠状动脉。我们试图验证并确定桡动脉脉搏波分析（PWA）的临床价值，这是一种评估中心动脉僵硬的简单、快速和非侵入性标志物，并确定其在高危患者中预测冠状动脉疾病的能力。
在一项前瞻性、多中心观察性研究[替代风险标志物在冠状动脉疾病（ARM-CAD）研究]中，评估了 531 例连续转诊行选择性冠状动脉造影的患者，无论先前是否存在合并症。
平均年龄为 65±11 岁，33%为女性，18%存在左心室功能障碍，22%有既往心肌梗死病史。在 20%的参与者中，造影显示正常的冠状动脉。与这一结果唯一独立相关的因素是年龄较小、女性、无糖尿病和 PWA 衍生的中心增强压<24mmHg。后者在调整药物和基线危险因素（包括血压、高敏 C 反应蛋白和 B 型利钠肽）后调整后的优势比为 3.4（95%CI 1.2 至 9.5；p=0.021）。纳入 PWA 的多变量模型的特异性为 95.7%，受试者工作特征曲线下面积为 0.876。验证研究表明，无论脉搏波质量如何，PWA 的收缩变量都很稳健，与测量的主动脉压相似（平均差异 2.7mmHg）。
桡动脉波形评估是一种有用的非侵入性临床检查方法，可分层评估冠状动脉疾病的可能性，并有助于识别需要进行诊断性血管造影的患者。
