心踝血管指数可能是经皮冠状动脉造影及介入术后隐匿性神经元损伤的重要标志物：一项关于诊断准确性的前瞻性观察研究。

Cardio-ankle vascular index may be an important marker of silent neuronal injury after percutaneous coronary angiography and intervention: a prospective observational study on diagnostic accuracy.

作者信息

Aykan Ahmet Çağrı, Gökdeniz Tayyar, Bektaş Hüseyin, Boyacı Faruk, Gül İlker, Kalaycıoğlu Ezgi, Hatem Engin, Turan Turhan

机构信息

Clinic of Cardiology, Ahi Evren Chest Cardiovascular Surgery Education and Research Hospital; Trabzon-Turkey.

出版信息

Anadolu Kardiyol Derg. 2014 Nov;14(7):606-11. doi: 10.5152/akd.2014.5011. Epub 2014 Feb 10.

DOI:10.5152/akd.2014.5011

PMID:25036323

Abstract

OBJECTIVE

The relationship between silent neuronal injury (SNI) and arterial stiffness assessed by cardio-ankle vascular index (CAVI) has not been evaluated in patients treated with coronary angiography and intervention due to acute coronary syndrome (ACS). The aim of this study is to evaluate the value of CAVI in prediction of SNI after percutaneous coronary angiography and intervention in patients presented with ACS.

METHODS

Eighty-three consecutive patients presented with ACS, who underwent percutaneous coronary angiography and intervention, were included in this prospective observational study on diagnostic accuracy. Neuron specific enolase (NSE) was studied before and 18 hour after the coronary angiography and intervention. CAVI was measured by VaSera-1000 instrument. Clinical and echocardiographic characteristics were analyzed and independent predictors of SNI were evaluated. Chi-square, Student t-test, Mann-Whithney U test, correlation analysis and logistic regression analysis was used for statistical analysis.

RESULTS

NSE levels significantly increased after cardiac catheterization (9.82±3.22 mg/dL vs. 13.15±8.55 mg/dL, p<0.001). CAVI (OR=2.992, 95% CI: 1.494-5.713, p=0.002), left ventricular ejection fraction (LVEF) (OR=0.911, 95% CI: 0.843-0.983, p=0.017) and undergoing percutaneous coronary intervention (OR=4.430, 95% CI: 1.034-18.97, p=0.045) were the independent predictors of SNI in logistic regression analysis. The cut-off value to show SNI for CAVI was 10.45 (sensitivity=71.8%, specificity=91.5%) in receiver operator charecteristic (ROC) curve analysis. The area under curve was 0.832 (95% CI=0.746-0.918, p<0.001).

CONCLUSION

Besides undergoing PCI and having LVEF, measurement of CAVI may be a useful tool for predicting the development of SNI after percutaneous coronary angiography and intervention in patients with ACS.

摘要

目的

在因急性冠状动脉综合征（ACS）接受冠状动脉造影和介入治疗的患者中，尚未评估通过心踝血管指数（CAVI）评估的隐匿性神经元损伤（SNI）与动脉僵硬度之间的关系。本研究的目的是评估CAVI在预测ACS患者经皮冠状动脉造影和介入治疗后SNI发生中的价值。

方法

本项关于诊断准确性的前瞻性观察研究纳入了83例连续接受经皮冠状动脉造影和介入治疗的ACS患者。在冠状动脉造影和介入治疗前及治疗后18小时检测神经元特异性烯醇化酶（NSE）。使用VaSera - 1000仪器测量CAVI。分析临床和超声心动图特征，并评估SNI的独立预测因素。采用卡方检验、学生t检验、曼 - 惠特尼U检验、相关性分析和逻辑回归分析进行统计分析。

结果

心导管检查后NSE水平显著升高（9.82±3.22mg/dL对13.15±8.55mg/dL，p<0.001）。在逻辑回归分析中，CAVI（OR = 2.992，95%CI：1.494 - 5.713，p = 0.002）、左心室射血分数（LVEF）（OR = 0.911，95%CI：0.843 - 0.983，p = 0.017）和接受经皮冠状动脉介入治疗（OR = 4.430，95%CI：1.034 - 18.97，p = 0.045）是SNI的独立预测因素。在受试者工作特征（ROC）曲线分析中，CAVI显示SNI的截断值为10.45（敏感性 = 71.8%，特异性 = 91.5%）。曲线下面积为0.832（95%CI = 0.746 - 0.918，p<0.001）。