Maeda Hirofumi, Sugiyama Seigo, Jinnouchi Hideaki, Matsuzawa Yasushi, Fujisue Koichiro, Hirata Yoshihiro, Kurokawa Hirofumi, Ohba Keisuke, Matsubara Junichi, Nozaki Toshimitsu, Konishi Masaaki, Akiyama Eiichi, Sugamura Koichi, Yamamoto Eiichiro, Sumida Hitoshi, Ogawa Hisao
Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan; Maeda Clinic of Internal Medicine, Kumamoto, Japan.
Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan; Diabetes Care Center, Jinnouchi Hospital, Kumamoto, Japan.
J Cardiol. 2016 May;67(5):455-62. doi: 10.1016/j.jjcc.2015.07.003. Epub 2015 Sep 4.
Polyvascular disease (PolyVD) refers to the coexistence of coronary artery disease (CAD), peripheral arterial disease (PAD), and/or cerebrovascular disease (CVD), and carries a high risk of cardiovascular mortality. Endothelial dysfunction plays a crucial role in cardiovascular pathophysiology. This study investigated the association between PolyVD and the presence of microvascular endothelial dysfunction.
Consecutive stable patients (n=533) with diabetes mellitus and/or multiple cardiovascular risk factors were enrolled. Peripheral microvascular endothelial function in the finger microvasculature was assessed using the reactive hyperemia peripheral arterial tonometry index (RHI), and ankle-brachial index was measured for diagnosis of lower-extremity PAD prior to coronary angiography. Diagnosis of CVD was based on clinical symptoms, carotid ultrasound, and magnetic resonance imaging. PolyVD was defined as two or more coexisting vascular diseases from CAD, lower-extremity PAD, and CVD.
Natural logarithmic transformations of RHI (Ln-RHI) were significantly attenuated in 93 patients with PolyVD (0.44±0.20) compared with those in 440 patients without PolyVD (0.56±0.19; p<0.001) or in 299 patients with a single vascular disease (0.54±0.19; p<0.001). There was an independent correlation between Ln-RHI (per 0.1) and the presence of PolyVD in all high-risk patients [odds ratio (OR): 0.724; 95% confidence interval (CI): 0.610-0.859; p<0.001] and one or more vascular diseases (OR: 0.724; 95% CI: 0.605-0.867, p<0.001). Receiver-operating characteristics curve analysis showed that Ln-RHI correlated significantly with PolyVD (area under the curve, 0.682, 95% CI: 0.625-0.740, p<0.001). The optimum cut-off point of Ln-RHI for the existence of PolyVD was 0.479.
Microvascular endothelial dysfunction is significantly associated with the presence of PolyVD. Severe impairment of endothelial function in peripheral microvasculature may be an important pathophysiological component of PolyVD.
多血管疾病（PolyVD）指冠状动脉疾病（CAD）、外周动脉疾病（PAD）和/或脑血管疾病（CVD）并存，具有较高的心血管死亡风险。内皮功能障碍在心血管病理生理学中起关键作用。本研究调查了PolyVD与微血管内皮功能障碍之间的关联。
纳入连续的533例患有糖尿病和/或多种心血管危险因素的稳定患者。在冠状动脉造影术前，使用反应性充血外周动脉张力测定指数（RHI）评估手指微血管中的外周微血管内皮功能，并测量踝臂指数以诊断下肢PAD。CVD的诊断基于临床症状、颈动脉超声和磁共振成像。PolyVD定义为CAD、下肢PAD和CVD中两种或更多种并存的血管疾病。
与440例无PolyVD的患者（0.56±0.19）或299例患有单一血管疾病的患者（0.54±0.19）相比，93例PolyVD患者的RHI自然对数转换值（Ln-RHI）显著降低（0.44±0.20；p<0.001）。在所有高危患者中，Ln-RHI（每0.1）与PolyVD的存在之间存在独立相关性[比值比（OR）：0.724；95%置信区间（CI）：0.610-0.859；p<0.001]以及与一种或多种血管疾病之间存在独立相关性（OR：0.724；95%CI：0.605-0.867，p<0.001）。受试者工作特征曲线分析表明，Ln-RHI与PolyVD显著相关（曲线下面积，0.682，95%CI：0.625-0.740，p<0.001）。PolyVD存在时Ln-RHI的最佳截断点为0.479。
微血管内皮功能障碍与PolyVD的存在显著相关。外周微血管内皮功能的严重受损可能是PolyVD的重要病理生理组成部分。
