使用示波法自动测量封闭区域血流介导的血管舒张功能评估的内皮功能是心血管事件的独立预测指标。
Endothelial Function Assessed by Automatic Measurement of Enclosed Zone Flow-Mediated Vasodilation Using an Oscillometric Method Is an Independent Predictor of Cardiovascular Events.
作者信息
Morimoto Haruka, Kajikawa Masato, Oda Nozomu, Idei Naomi, Hirano Harutoyo, Hida Eisuke, Maruhashi Tatsuya, Iwamoto Yumiko, Kishimoto Shinji, Matsui Shogo, Aibara Yoshiki, Hidaka Takayuki, Kihara Yasuki, Chayama Kazuaki, Goto Chikara, Noma Kensuke, Nakashima Ayumu, Ukawa Teiji, Tsuji Toshio, Higashi Yukihito
机构信息
Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
Nihon Kohden Co., Tokyo, Japan.
出版信息
J Am Heart Assoc. 2016 Dec 21;5(12):e004385. doi: 10.1161/JAHA.116.004385.
BACKGROUND
A new device for automatic measurement of flow-mediated vasodilation (FMD) using an oscillometric method has been developed to solve technical problems of conventional FMD measurement. This device measures enclosed zone FMD (ezFMD). The purpose of this study was to evaluate the prognostic value of endothelial function assessed by ezFMD for future cardiovascular events.
METHODS AND RESULTS
We measured ezFMD in 272 participants who underwent health-screening examinations. First, we investigated cross-sectional associations between ezFMD and cardiovascular risk factors, and then we assessed the associations between ezFMD and first major cardiovascular events (death from cardiovascular causes, stroke, and coronary revascularization). Univariate regression analysis revealed that ezFMD was significantly correlated with age, triglycerides, glucose, smoking pack-years, estimated glomerular filtration rate, high-sensitivity C-reactive protein, and Framingham risk score. During a median follow-up period of 36.1 months (interquartile range 18.8-40.1 months), 12 participants died (6 from cardiovascular causes), 3 had stroke, 8 had coronary revascularization, and 10 were hospitalized for heart failure. There was no episode of acute coronary syndrome during the study period. Participants were divided into tertiles (low, intermediate, and high) based on ezFMD. Kaplan-Meier curves for first major cardiovascular events among the 3 groups were significantly different (P=0.004). After adjustment for cardiovascular risk factors, the low group was significantly associated with an increased risk of first major cardiovascular events compared with the high group (hazard ratio 6.47; 95% CI 1.09-125.55; P=0.038).
CONCLUSIONS
These findings suggest that endothelial function assessed by ezFMD may be useful as a surrogate marker of future cardiovascular events.
CLINICAL TRIAL REGISTRATION
URL: https://upload.umin.ac.jp. Unique identifier: UMIN000004902.
背景
为解决传统血流介导的血管舒张功能（FMD）测量的技术问题，已开发出一种使用示波法自动测量FMD的新设备。该设备测量封闭区域FMD（ezFMD）。本研究的目的是评估通过ezFMD评估的内皮功能对未来心血管事件的预后价值。
方法与结果
我们对272名接受健康筛查的参与者测量了ezFMD。首先，我们研究了ezFMD与心血管危险因素之间的横断面关联，然后评估了ezFMD与首次重大心血管事件（心血管原因死亡、中风和冠状动脉血运重建）之间的关联。单因素回归分析显示，ezFMD与年龄、甘油三酯、血糖、吸烟包年数、估计肾小球滤过率、高敏C反应蛋白和弗雷明汉风险评分显著相关。在中位随访期36.1个月（四分位间距18.8 - 40.1个月）内，12名参与者死亡（6例因心血管原因），3例发生中风，8例进行了冠状动脉血运重建，10例因心力衰竭住院。研究期间无急性冠状动脉综合征发作。参与者根据ezFMD分为三分位数（低、中、高）。三组中首次重大心血管事件的Kaplan-Meier曲线有显著差异（P = 0.004）。在调整心血管危险因素后，与高分组相比，低分组首次重大心血管事件的风险显著增加（风险比6.47；95%可信区间1.09 - 125.55；P = 0.038）。
结论
这些发现表明，通过ezFMD评估的内皮功能可能作为未来心血管事件的替代标志物。
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