Sugamata Wataru, Nakamura Takamitsu, Uematsu Manabu, Kitta Yoshinobu, Fujioka Daisuke, Saito Yukio, Kawabata Ken-ichi, Obata Jun-ei, Watanabe Yosuke, Watanabe Kazuhiro, Kugiyama Kiyotaka
University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan.
University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan.
J Cardiol. 2014 Sep;64(3):179-84. doi: 10.1016/j.jjcc.2014.01.004. Epub 2014 Feb 17.
Measurement of either flow-mediated endothelium-dependent dilatation (FMD) of the brachial artery, brachial-ankle pulse wave velocity (baPWV), or intima-media thickness (IMT) of the carotid artery is useful for risk assessment of future cardiovascular events. This study examined whether combination of these vascular parameters may have an additive effect on the ability of traditional risk factors to predict coronary events in patients with chronic coronary artery disease (CAD).
Patients (n=923) with stable CAD had measurements of FMD, baPWV, and maximum IMT (maxIMT), and were prospectively followed up for <8.5 years or until a coronary event - cardiac death, non-fatal myocardial infarction (MI) or unstable angina pectoris (uAP) requiring unplanned coronary revascularization.
During the follow-up period, 116 events occurred (29 cardiac deaths, 46 non-fatal MIs and 41 cases of uAP). A multivariate Cox proportional hazards analysis showed that FMD (HR 0.50, 95% CI 0.38-0.66) and baPWV (HR 1.52, 95% CI 1.27-1.82) but not maxIMT were significant predictors of coronary events. Based on the concordance statistics, the predictive value of traditional risk factors [area under the receiver operating characteristic curve (AUC), 0.67] was increased more by the addition of FMD and baPWV combined (AUC, 0.75) compared with the addition of either maxIMT, FMD, or baPWV alone, or the combination of maxIMT and FMD or maxIMT and baPWV (AUC, 0.67, 0.71, 0.71, 0.71 and 0.71, respectively).
The combined addition of FMD and baPWV to the risk assessment algorithms may be useful for risk stratification of chronic CAD patients.
测量肱动脉血流介导的内皮依赖性舒张功能（FMD）、臂踝脉搏波速度（baPWV）或颈动脉内膜中层厚度（IMT），对于未来心血管事件的风险评估很有用。本研究探讨了这些血管参数的组合是否可能对传统危险因素预测慢性冠状动脉疾病（CAD）患者冠状动脉事件的能力产生累加效应。
对923例稳定型CAD患者进行FMD、baPWV和最大IMT（maxIMT）测量，并对其进行前瞻性随访<8.5年，或直至发生冠状动脉事件——心源性死亡、非致死性心肌梗死（MI）或需要进行非计划性冠状动脉血运重建的不稳定型心绞痛（uAP）。
在随访期间，发生了116起事件（29例心源性死亡、46例非致死性MI和41例uAP）。多变量Cox比例风险分析显示，FMD（风险比0.50，95%置信区间0.38 - 0.66）和baPWV（风险比1.52，95%置信区间1.27 - 1.82）是冠状动脉事件的显著预测因子，但maxIMT不是。基于一致性统计，与单独添加maxIMT、FMD或baPWV，或maxIMT与FMD或maxIMT与baPWV的组合相比，联合添加FMD和baPWV可使传统危险因素的预测价值[受试者操作特征曲线下面积（AUC），0.67]增加更多（AUC，0.75）（AUC分别为0.67、0.71、0.71、0.71和0.71）。
在风险评估算法中联合添加FMD和baPWV，可能有助于慢性CAD患者的风险分层。
