Prasad Megha, McBane Robert, Reriani Martin, Lerman Lilach O, Lerman Amir
Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Thromb Res. 2016 Mar;139:17-21. doi: 10.1016/j.thromres.2015.12.024. Epub 2015 Dec 29.
Normal endothelial function is central to physiologic anticoagulation mechanisms. Endothelial dysfunction may predispose to venous thromboembolism (VTE). We aimed to investigate if coronary endothelial dysfunction (CED) predicts development of VTE in patients presenting with coronary atherosclerosis without critical stenoses.
Coronary microvascular function was evaluated in 502 patients with coronary atherosclerosis without critical stenoses by administration of intracoronary acetylcholine at the time of diagnostic study. After a median follow-up of 6.3years, patients were assessed for the development of VTE by administration of a questionnaire. Coronary microvascular endothelial dysfunction was defined as ≤50% increase in coronary blood flow from baseline in response to maximal dose of acetylcholine.
The median age was 53years (IQR: 45, 62) 68% were female and CED occurred in 279 (56%) patients. Hypertension (40.8%), diabetes (8.4%), and hyperlipidemia (58.3%) were common risk factors. There were no differences in baseline characteristics between those with and without CED. There were 9 VTE events (6 unprovoked) among patients with CED compared to no events in the control group (P=0.01).
CED was associated with the development of VTE. Endothelial injury by causing disruption of vascular hemostasis may play a role in predisposing patients to VTE.
正常的内皮功能是生理抗凝机制的核心。内皮功能障碍可能易导致静脉血栓栓塞（VTE）。我们旨在研究冠状动脉内皮功能障碍（CED）是否能预测无严重狭窄的冠状动脉粥样硬化患者发生VTE的情况。
在502例无严重狭窄的冠状动脉粥样硬化患者进行诊断性研究时，通过冠状动脉内注射乙酰胆碱来评估冠状动脉微血管功能。在中位随访6.3年后，通过问卷调查评估患者VTE的发生情况。冠状动脉微血管内皮功能障碍定义为在最大剂量乙酰胆碱作用下，冠状动脉血流较基线增加≤50%。
中位年龄为53岁（四分位间距：45，62），68%为女性，279例（56%）患者发生CED。高血压（40.8%）、糖尿病（8.4%）和高脂血症（58.3%）是常见危险因素。有CED和无CED患者的基线特征无差异。CED患者中有9例发生VTE事件（6例为非诱因性），而对照组无事件发生（P = 0.01）。
CED与VTE的发生相关。内皮损伤通过破坏血管止血可能在使患者易患VTE方面起作用。
