Department of Cardiology, Fujisawa Shonandai Hospital, Kanagawa, Japan.
Department of Cardiology, Fujisawa Shonandai Hospital, Kanagawa, Japan.
Atherosclerosis. 2017 Dec;267:146-152. doi: 10.1016/j.atherosclerosis.2017.11.003. Epub 2017 Nov 3.
Endothelial dysfunction and coronary artery calcification (CAC) may represent two distinct and separate processes in the development of coronary atherosclerosis. However, the interaction between these factors in determining the development of coronary artery disease (CAD) is uncertain.
Brachial artery flow-mediated dilatation (FMD) was measured by high-resolution ultrasound before coronary angiography, in 156 patients undergoing coronary CT angiography on suspicion of CAD (M/F 100/56, age 67 ± 11yrs). CAC score was measured with the Agatston method.
The discriminative performance of FMD and CAC score in predicting the presence of type C lesion, multivessel disease, and high SYNTAX score (>22) was determined by ROC curve analysis. The optimal cutoff values for type C lesion were FMD ≤3.70% (AUC 0.663, p = 0.037) and log(CACscore+1)≥ 6.452 (AUC 0.735, p = 0.006). The combination of these cutoff values identified the lesion with the highest predictive accuracy of 82%. In addition, the optimal cutoff values for multivessel disease were FMD ≤5.40% (AUC 0.689, p = 0.001) and log(CACscore+1)≥ 5.914 (AUC 0.731, p = 0.001), while those for high SYNTAX score were FMD ≤4.10% (AUC 0.664, p = 0.020) and log(CACscore+1) ≥6.693 (AUC 0.817, p = 0.001). The combined measurement of each cutoff value identified multivessel disease and high SYNTAX score with predictive accuracy of 77% and 83%, respectively, which were significantly higher than each parameter alone, with the exception of the predictive accuracy of log(CACscore+1) for high SYNTAX score (p = 0.083).
Endothelial dysfunction and CAC may provide complementary information in predicting the extent and severity of coronary artery disease.
内皮功能障碍和冠状动脉钙化（CAC）可能代表冠状动脉粥样硬化发展过程中的两个不同且独立的过程。然而，这些因素在决定冠状动脉疾病（CAD）的发展中的相互作用尚不确定。
在怀疑患有 CAD 的 156 名接受冠状动脉 CT 血管造影的患者中（M/F 100/56，年龄 67±11 岁），通过高分辨率超声在冠状动脉造影前测量肱动脉血流介导的扩张（FMD）。使用 Agatston 方法测量 CAC 评分。
通过 ROC 曲线分析确定 FMD 和 CAC 评分在预测 C 型病变、多血管病变和高 SYNTAX 评分（>22）方面的区分性能。C 型病变的最佳截断值为 FMD≤3.70%（AUC 0.663，p=0.037）和 log（CACscore+1）≥6.452（AUC 0.735，p=0.006）。这些截断值的组合确定了具有最高预测准确性的病变，准确率为 82%。此外，多血管病变的最佳截断值为 FMD≤5.40%（AUC 0.689，p=0.001）和 log（CACscore+1）≥5.914（AUC 0.731，p=0.001），而高 SYNTAX 评分的最佳截断值为 FMD≤4.10%（AUC 0.664，p=0.020）和 log（CACscore+1）≥6.693（AUC 0.817，p=0.001）。每个截断值的联合测量确定了多血管疾病和高 SYNTAX 评分的预测准确性分别为 77%和 83%，明显高于单独使用每个参数的预测准确性，除了 log（CACscore+1）对高 SYNTAX 评分的预测准确性（p=0.083）外。
内皮功能障碍和 CAC 可能提供有关冠状动脉疾病程度和严重程度的补充信息。
