Trojnarska Olga, Szczepaniak-Chicheł Ludwina, Gabriel Marcin, Bartczak-Rutkowska Agnieszka, Rupa-Matysek Joanna, Tykarski Andrzej, Grajek Stefan
Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland.
Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland.
J Cardiol. 2017 Jul;70(1):62-67. doi: 10.1016/j.jjcc.2016.09.003. Epub 2016 Oct 15.
Mortality in cyanotic patients with congenital heart diseases (CHD) is high, mainly due to cardiovascular complications. It is known that endothelial dysfunction, increased arterial stiffness, and impaired vascular function have negative influence on cardiovascular prognosis. The aim of the study was to assess parameters of arterial stiffness and vascular dysfunction in cyanotic patients with CHD as well as their potential relation to impaired blood oxygen saturation and polycythemia parameters typical for cyanosis.
A total of 36 CHD cyanotic patients (17 males) (42.3±16.3 years) and 35 healthy individuals (16 males) (39.6±10.4 years) were enrolled. Assessed parameters were intima media thickness and flow-mediated dilatation (FMD). Assessed parameters using applanation tonometry methods were aortic systolic pressure, aortic pulse pressure (AoPP), augmentation pressure (AP), augmentation index (AI), pulse pressure amplification (PPampl), and pulse wave velocity (PWV).
AoPP (37.3±11.1mmHg vs. 29±6.5mmHg; p=0.002), AP (10.1±7.3mmHg vs. 1.1±3.9mmHg; p=0.00001), AI (24.7±13.5% vs. 3.0±13.6%; p=0.00001), and PWV (7.4±2.1m/s vs. 6.3±0.7m/s; p=0.003) were higher, and PPampl was lower (135.3±16.1% vs. 160.4±12.8%; p=0.00001) in the studied group compared to controls and proved the presence of the increased stiffness of arteries. Impairment of FMD was observed (9.0±5.6 vs. 10.9±4.7; p=0.04). No significant correlations were found between analyzed arterial parameters and biochemical ones characterizing cyanotic patients depicting rheological properties of blood.
Cyanotic patients with CHD are characterized by increased arterial stiffness estimated with pulse wave analysis parameters and by deteriorated arterial function expressed with worse vasodilatative response in comparison with healthy population. It may confirm relevance of those mechanisms in development of increased rate of cardiovascular events in this population. Association between oxygen saturation or polycythemia and arterial stiffening or vascular dysfunction was not found in these patients.
患有先天性心脏病（CHD）的青紫型患者死亡率很高，主要是由于心血管并发症。已知内皮功能障碍、动脉僵硬度增加和血管功能受损对心血管预后有负面影响。本研究的目的是评估CHD青紫型患者的动脉僵硬度和血管功能障碍参数，以及它们与血氧饱和度受损和青紫典型的红细胞增多症参数之间的潜在关系。
共纳入36例CHD青紫型患者（17例男性）（42.3±16.3岁）和35例健康个体（16例男性）（39.6±10.4岁）。评估的参数包括内膜中层厚度和血流介导的血管舒张功能（FMD）。使用压平式眼压计方法评估的参数有主动脉收缩压、主动脉脉压（AoPP）、增强压（AP）、增强指数（AI）、脉压放大率（PPampl）和脉搏波速度（PWV）。
与对照组相比，研究组的AoPP（37.3±11.1mmHg对29±6.5mmHg；p = 0.002）、AP（10.1±7.3mmHg对1.1±3.9mmHg；p = 0.00001）、AI（24.7±13.5%对3.0±13.6%；p = 0.00001）和PWV（7.4±2.1m/s对6.3±0.7m/s；p = 0.003）更高，而PPampl更低（135.3±16.1%对160.4±12.8%；p = 0.00001），这证明存在动脉僵硬度增加的情况。观察到FMD受损（9.0±5.6对10.9±4.7；p = 0.04）。在所分析的动脉参数与表征青紫型患者血液流变学特性的生化参数之间未发现显著相关性。
与健康人群相比，CHD青紫型患者的特征是通过脉搏波分析参数评估的动脉僵硬度增加，以及以较差的血管舒张反应表示的动脉功能恶化。这可能证实了这些机制在该人群心血管事件发生率增加的发展过程中的相关性。在这些患者中未发现血氧饱和度或红细胞增多症与动脉僵硬度或血管功能障碍之间的关联。
