Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands.
Research institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom.
Ann Surg. 2019 Apr;269(4):767-773. doi: 10.1097/SLA.0000000000002558.
Patients with peripheral arterial disease (PAD) have increased risk on future cerebro- and cardiovascular events. Our aim was to examine whether carotid artery reactivity (CAR; a novel, simple procedure to examine endothelial function) predicts cardiovascular events in PAD patients.
Increased risk for future cardiovascular events in PAD patients is likely related to endothelial dysfunction, highlighting the necessity for simple assessment of endothelial function.
A total of 172 PAD patients (68 ± 10 years, 67% male) underwent the CAR, which involves ultrasound measurement of carotid artery diameter during sympathetic stimulation produced by 90-second hand immersion in 4°C ice-water (ie, cold pressor test). CAR-responses were dichotomized into carotid constriction or dilation. We recorded cardiac and cerebrovascular events, mortality, and clinical progression to percutaneous transluminal angioplasty or loss of patency during 12-month follow-up.
Eighty-two PAD patients demonstrated carotid constriction and 90 patients demonstrated dilation. PAD patients with carotid constriction showed more cardiovascular events compared to patients with dilation (Kaplan-Meier Log rank; P < 0.05). Cox proportional hazard models showed that patients with carotid constriction continued to show higher risk for cardiovascular events [hazard ratio: 4.1; 95% confidence interval (CI), 1.3-12.5] and clinical progression (hazard ratio: 2.0; 95% CI, 1.2-3.3), even after adjustment for other risk factors. Ankle brachial pressure index and carotid intima-medial thickness alone did not predict (cardiovascular) event or improve risk assessment beyond that provided by CAR.
Carotid vasoconstriction identifies PAD patients with a 4-fold increased risk for future cardiovascular events and 2-fold increased risk for clinical deterioration. CAR provides a simple, novel strategy to predict cardiovascular events and progression in PAD patients.
www.trialregister.nl/trialreg/index.asp, NTR-4117.
外周动脉疾病（PAD）患者未来发生心脑血管事件的风险增加。本研究旨在探讨颈动脉反应性（CAR；一种评估内皮功能的新型简单方法）是否可预测 PAD 患者的心血管事件。
PAD 患者未来发生心血管事件的风险增加可能与内皮功能障碍有关，这突出表明需要对内皮功能进行简单评估。
共纳入 172 例 PAD 患者（68±10 岁，67%为男性），采用超声测量交感神经刺激（90 秒手浸入 4°C 冰水，即冷加压试验）时颈动脉直径，评估颈动脉反应性。将 CAR 反应分为颈动脉收缩或扩张。我们记录了 12 个月随访期间的心脏和脑血管事件、死亡率以及经皮腔内血管成形术进展或再狭窄。
82 例 PAD 患者出现颈动脉收缩，90 例患者出现颈动脉扩张。与颈动脉扩张患者相比，颈动脉收缩患者的心血管事件更多（Kaplan-Meier Log rank；P<0.05）。Cox 比例风险模型显示，颈动脉收缩患者持续存在更高的心血管事件风险[风险比：4.1；95%置信区间（CI）：1.3-12.5]和临床进展风险[风险比：2.0；95%CI：1.2-3.3]，即使在调整其他危险因素后也是如此。单独的踝臂血压指数和颈动脉内膜中层厚度并不能预测（心血管）事件或改善 CAR 提供的风险评估。
颈动脉收缩可识别出未来发生心血管事件风险增加 4 倍、临床恶化风险增加 2 倍的 PAD 患者。CAR 提供了一种简单的新型策略，可预测 PAD 患者的心血管事件和进展。
