Perri Ludovica, Pastori Daniele, Pignatelli Pasquale, Violi Francesco, Loffredo Lorenzo
I Clinica Medica, Sapienza University, Rome, Italy.
I Clinica Medica, Sapienza University, Rome, Italy.
Int J Cardiol. 2015 Jan 20;179:139-43. doi: 10.1016/j.ijcard.2014.10.039. Epub 2014 Nov 10.
Atrial fibrillation is associated with multiple atherosclerotic risk factors and predisposes to cardiovascular events (CVE). Endothelial dysfunction is associated with atherosclerosis and independently predicts CVE. The aim of the study was to evaluate the association between endothelial dysfunction, as assessed by flow-mediated dilation (FMD), and CVE in AF patients.
We prospectively measured FMD in 514 non-valvular AF patients on anticoagulant treatment with vitamin K antagonists. Patients were followed-up for a mean time of 23.5 months. The main composite outcome of the study was the occurrence of stroke/TIA, myocardial infarction, urgent revascularization and cardiovascular death.
Median value of FMD was 4.6% [IQR 1.46-8.00]. A CVE occurred in 44 patients (8.56%):non-fatal myocardial infarction (MI) in 7, fatal MI in 2, stent/coronary artery by-pass graft (CABG) in 10, ischemic non-fatal stroke in 10, fatal stroke in 3, transient ischemic attack (TIA) in 1, and cardiovascular death in 11 patients. Patients who experienced a CVE showed significantly reduced FMD compared to those who did not (3.06% [IQR 0.00-6.00] vs 4.67% [IQR 1.58-8.22], p=0.027). During a mean follow-up of 23.5 months, the rate of CVE was significantly higher in subjects with FMD below median (<4.6%) than in those with FMD above median (27 vs 17, log-rank test p=0.006). COX analysis demonstrated that low FMD (below median) (HR: 2.20, CI 95%:1.13-4.28, p=0.020), age (HR: 1.08, CI 95%: 1.03-1.12, p<0.001), smoking (HR: 4.15, CI 95%: 1.63-10.6, p=0.003) and history of stroke/TIA (HR: 2.38, CI 95%: 1.13-5.04, p=0.023) independently predicted CVE.
In AF patients low FMD is associated with increased risk of CVE suggesting that impaired artery dilatation predisposes to atherosclerotic complications.
心房颤动与多种动脉粥样硬化危险因素相关，并易引发心血管事件（CVE）。内皮功能障碍与动脉粥样硬化相关，且可独立预测CVE。本研究旨在评估通过血流介导的血管舒张（FMD）评估的内皮功能障碍与房颤患者CVE之间的关联。
我们前瞻性地测量了514例接受维生素K拮抗剂抗凝治疗的非瓣膜性房颤患者的FMD。患者平均随访23.5个月。本研究的主要复合结局是中风/短暂性脑缺血发作（TIA）、心肌梗死、紧急血运重建和心血管死亡的发生。
FMD的中位数为4.6%[四分位间距1.46 - 8.00]。44例患者（8.56%）发生了CVE：7例非致命性心肌梗死（MI），2例致命性MI，10例行支架/冠状动脉搭桥术（CABG），10例缺血性非致命性中风，3例致命性中风，1例短暂性脑缺血发作（TIA），11例心血管死亡。发生CVE的患者与未发生CVE的患者相比，FMD显著降低（3.06%[四分位间距0.00 - 6.00] vs 4.67%[四分位间距1.58 - 8.22]，p = 0.027）。在平均23.5个月的随访期间，FMD低于中位数（<4.6%）的受试者CVE发生率显著高于FMD高于中位数者（27例对17例；对数秩检验p = 0.006）。COX分析表明，低FMD（低于中位数）（风险比：2.20，95%置信区间：1.13 - 4.28，p = 0.020）、年龄（风险比：1.08，95%置信区间：1.03 - 1.12，p < 0.001）、吸烟（风险比：4.15，95%置信区间：1.63 - 10.6，p = 0.003）和中风/TIA病史（风险比：2.38，95%置信区间：1.13 - 5.04，p = 0.023）可独立预测CVE。
在房颤患者中，低FMD与CVE风险增加相关，提示动脉扩张受损易引发动脉粥样硬化并发症。
