Cusmà-Piccione Maurizio, Zito Concetta, Khandheria Bijoy K, Pizzino Fausto, Di Bella Gianluca, Antonini-Canterin Francesco, Vriz Olga, Bello Vito Antonio Di, Zimbalatti Carmelo, La Carrubba Salvatore, Oreto Giuseppe, Carerj Scipione
aClinical and Experimental Department of Medicine, University of Messina, Messina, Italy bAurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, USA cCardiology Unit, ARC, S. Maria degli Angeli Hospital, Pordenone dCardiology Unit, O.C. San Antonio, San Daniele del Friuli, Udine eCardiac Thoracic and Vascular Department, University of Pisa, Pisa fInternal Medicine, Villa Sofia Hospital, Palermo, Italy.
J Cardiovasc Med (Hagerstown). 2014 Nov;15(11):797-802. doi: 10.2459/JCM.0000000000000185.
A relationship between arterial stiffening and coronary flow abnormalities, although not fully elucidated, has been observed. The purpose of this study was to investigate the relationship among carotid stiffness, measured using echo-tracking, and Doppler parameters of coronary blood flow, sampled at the left anterior descending (LAD) artery.
We studied 88 consecutive patients (49 men, mean age 51.2 ± 16.2 years) with cardiovascular risk factors but without history of cardiovascular diseases. Each patient underwent echocardiographic evaluation for measurement of the diastolic velocity time integral (DVTI) and calculation of the diastolic velocity time integral coronary index (DVTICI), the ratio between DVTI and total velocity time integral of LAD artery flow × 100, and carotid ultrasound for measurement of carotid intima media thickness (IMT) and stiffness parameters such as β index and elastic modulus (Ep).
DVTICI was significantly greater in men than in women (median 82, interquartile range 78-86 vs. median 80, interquartile range 73-83, respectively; P < 0.016). After correlating DVTICI with other variables, a significant inverse relation was obtained with β index (Rho = -0.449, P < 0.001), Ep (Rho = -0.478, P < 0.001), age (Rho = -0.52, P < 0.001), left ventricular mass index (Rho = -0.543, P < 0.001), E/E' (Rho = -0.411, P < 0.001), pulse pressure (Rho = -0.417, P < 0.001) and IMT (Rho = -0.480, P < 0.001). With linear multiple regression analysis, only β index (P < 0.001), Ep (P < 0.001), male sex (P < 0.001) and left ventricular mass index (P = 0.008) were independently associated with reduction of DVTICI.
Increased arterial stiffness, directly affecting coronary perfusion, is associated with reduced diastolic coronary flow. Echo-tracking for feasible measurement of carotid artery stiffness parameters may be valuable in more accurate cardiovascular risk stratification.
尽管动脉僵硬度与冠状动脉血流异常之间的关系尚未完全阐明，但已有相关观察。本研究旨在探讨使用回声跟踪测量的颈动脉僵硬度与在左前降支（LAD）动脉采集的冠状动脉血流多普勒参数之间的关系。
我们连续研究了88例有心血管危险因素但无心血管疾病病史的患者（49名男性，平均年龄51.2±16.2岁）。每位患者均接受超声心动图评估，以测量舒张期速度时间积分（DVTI）并计算舒张期速度时间积分冠状动脉指数（DVTICI），即DVTI与LAD动脉血流总速度时间积分的比值×100，同时接受颈动脉超声检查，以测量颈动脉内膜中层厚度（IMT）和僵硬度参数，如β指数和弹性模量（Ep）。
男性的DVTICI显著高于女性（中位数分别为82，四分位间距78 - 86；中位数80，四分位间距73 - 83；P < 0.016）。将DVTICI与其他变量进行相关性分析后，发现其与β指数（Rho = -0.449，P < 0.001）、Ep（Rho = -0.478，P < 0.001）、年龄（Rho = -0.52，P < 0.001）、左心室质量指数（Rho = -0.543，P < 0.001）、E/E'（Rho = -0.411，P < 0.001）、脉压（Rho = -0.417，P < 0.001）和IMT（Rho = -0.480，P < 0.001）呈显著负相关。通过线性多元回归分析，只有β指数（P < 0.001）、Ep（P < 0.001）、男性性别（P < 0.001）和左心室质量指数（P = 0.008）与DVTICI的降低独立相关。
动脉僵硬度增加直接影响冠状动脉灌注，与舒张期冠状动脉血流减少有关。回声跟踪用于可行地测量颈动脉僵硬度参数可能对更准确的心血管风险分层有价值。
