血流介导的血管舒张与硝酸甘油诱导的血管舒张相结合对预测心血管事件更有效。
Combination of Flow-Mediated Vasodilation and Nitroglycerine-Induced Vasodilation Is More Effective for Prediction of Cardiovascular Events.
作者信息
Kajikawa Masato, Maruhashi Tatsuya, Hida Eisuke, Iwamoto Yumiko, Matsumoto Takeshi, Iwamoto Akimichi, Oda Nozomu, Kishimoto Shinji, Matsui Shogo, Hidaka Takayuki, Kihara Yasuki, Chayama Kazuaki, Goto Chikara, Aibara Yoshiki, Nakashima Ayumu, Noma Kensuke, Higashi Yukihito
机构信息
From the Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine (M.K., Y.A., A.N., Y.H.), Global Career Design Center (M.K.), Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences (T. Maruhashi., Y.I., T. Matsumoto., A.I., N.O., S.K., S.M., T.H., Y.K.), and Department of Gastroenterology and Metabolism, Institute of Biomedical and Health Sciences, Graduate School of Biomedical and Health Sciences (K.C.), Hiroshima University, Hiroshima, Japan; Center for Integrated Medical Research (E.H.) and Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research (K.N., Y.H.), Hiroshima University Hospital, Hiroshima, Japan; and Department of Physical Therapy, Hiroshima International University, Hiroshima, Japan (C.G.).
出版信息
Hypertension. 2016 May;67(5):1045-52. doi: 10.1161/HYPERTENSIONAHA.115.06839. Epub 2016 Mar 14.
UNLABELLED
Measurement of nitroglycerine-induced vasodilation has been performed to differentiate endothelium-dependent vasodilation from endothelium-independent vasodilation as a control test for flow-mediated vasodilation (FMD). Recently, nitroglycerine-induced vasodilation per se has been reported to be a useful marker of the grade of atherosclerosis. The present study aimed to evaluate the prognostic value of FMD combined with nitroglycerine-induced vasodilation for future cardiovascular events. We measured FMD and nitroglycerine-induced vasodilation in 402 subjects, including patients with cardiovascular diseases. During a median follow-up period of 32.3 months, 38 first major cardiovascular events (death from cardiovascular causes, acute myocardial infarction, stroke, and coronary revascularization) occurred. Receiver-operator characteristic curve analysis revealed that FMD alone and nitroglycerine-induced vasodilation alone can predict cardiovascular events with areas under the curve of 0.671 (cutoff 3.3%) and 0.692 (cutoff 11.6%), respectively. FMD combined with nitroglycerine-induced vasodilation predicts cardiovascular events with an area under the curve of 0.701. After adjustment for age, sex, and cardiovascular risk factors, above cutoff FMD (≥3.3%) and below cutoff nitroglycerine-induced vasodilation (<11.6%; hazard ratio, 5.55; 95% confidence interval, 1.61-25.46;P=0.006) and below cutoff FMD (<3.3%) and below cutoff nitroglycerine-induced vasodilation (<11.6%; hazard ratio, 7.20; 95% confidence interval, 2.37-31.36;P<0.001) remained strong independent indicator of cardiovascular events. These findings suggest that the combination of FMD and nitroglycerine-induced vasodilation measurements can more accurately predict cardiovascular events compared with FMD alone.
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: UMIN000001167.
未标注
已进行硝酸甘油诱导的血管舒张测量，以区分内皮依赖性血管舒张和非内皮依赖性血管舒张，作为血流介导的血管舒张（FMD）的对照试验。最近，据报道硝酸甘油诱导的血管舒张本身是动脉粥样硬化程度的一个有用标志物。本研究旨在评估FMD联合硝酸甘油诱导的血管舒张对未来心血管事件的预后价值。我们测量了402名受试者（包括心血管疾病患者）的FMD和硝酸甘油诱导的血管舒张。在中位随访期32.3个月期间，发生了38例首次重大心血管事件（心血管原因死亡、急性心肌梗死、中风和冠状动脉血运重建）。受试者工作特征曲线分析显示，单独的FMD和单独的硝酸甘油诱导的血管舒张可预测心血管事件，曲线下面积分别为0.671（临界值3.3%）和0.692（临界值11.6%）。FMD联合硝酸甘油诱导的血管舒张预测心血管事件的曲线下面积为0.701。在调整年龄、性别和心血管危险因素后，高于临界值的FMD（≥3.3%）和低于临界值的硝酸甘油诱导的血管舒张（<1,1.6%；风险比，5.55；95%置信区间，1.61 - 25.46；P = 0.006）以及低于临界值的FMD（<3.3%）和低于临界值的硝酸甘油诱导的血管舒张（<11.6%；风险比，7.20；95%置信区间，2.37 - 31.36；P < 0.001）仍然是心血管事件的强有力独立指标。这些发现表明，与单独的FMD相比，FMD和硝酸甘油诱导的血管舒张测量相结合可以更准确地预测心血管事件。
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