利用心脏正电子发射断层扫描评估冠状动脉血管功能与血清尿酸的关系。
Assessment of coronary vascular function with cardiac PET in relation to serum uric acid.
作者信息
Kim Seoyoung C, Shah Nishant R, Rogers James R, Bibbo Courtney F, Di Carli Marcelo F, Solomon Daniel H
机构信息
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
出版信息
PLoS One. 2018 Feb 13;13(2):e0192788. doi: 10.1371/journal.pone.0192788. eCollection 2018.
BACKGROUND
Elevated serum uric acid (SUA) levels have been independently associated with cardiovascular disease. Stress myocardial perfusion positron emission tomography (PET) allows for measurement of absolute myocardial blood flow (MBF) and quantification of global left ventricular coronary flow reserve (CFR). A CFR <2.0 is considered impaired coronary vascular function, and it is associated with increased cardiovascular risk. We evaluated the relationship between SUA and PET-measured markers of coronary vascular function.
METHODS
We studied adults undergoing a stress myocardial perfusion PET on clinical grounds (1/2006-3/2014) who also had ≥1 SUA measurement within 180 days from the PET date. Multivariable linear regression estimated the association between SUA and PET-derived MBF and CFR. We also stratified analyses by diabetes status.
RESULTS
We included 382 patients with mean (SD) age of 68.4 (12.4) years and mean (SD) SUA level of 7.2 (2.6) mg/dl. 36% were female and 29% had gout. Median [IQR] CFR was reduced at 1.6 [1.2, 2.0] and median [IQR] stress MBF was 1.5 [1.1, 2.1] ml/min/g. In the adjusted analysis, SUA was inversely associated with stress MBF (β = -0.14, p = 0.01) but not with CFR. Among patients without diabetes (n = 215), SUA had a negative association with CFR (β = -0.15, p = 0.02) and stress MBF (β = -0.19, p = 0.01) adjusting for age, sex, extent of myocardial scar and ischemia, serum creatinine and gout. In diabetic patients (n = 167), SUA was not associated with either CFR or MBF.
CONCLUSIONS
In this cross-sectional study, higher SUA is modestly associated with worse CFR and stress MBF among patients without diabetes.
背景
血清尿酸（SUA）水平升高已被独立证实与心血管疾病相关。应激心肌灌注正电子发射断层扫描（PET）可用于测量绝对心肌血流量（MBF）并量化整体左心室冠状动脉血流储备（CFR）。CFR<2.0被认为是冠状动脉血管功能受损，且与心血管风险增加相关。我们评估了SUA与PET测量的冠状动脉血管功能标志物之间的关系。
方法
我们研究了因临床原因接受应激心肌灌注PET检查的成年人（2006年1月至2014年3月），这些人在PET检查日期后的180天内也进行了≥1次SUA测量。多变量线性回归估计了SUA与PET衍生的MBF和CFR之间的关联。我们还按糖尿病状态进行了分层分析。
结果
我们纳入了382例患者，平均（标准差）年龄为68.4（12.4）岁，平均（标准差）SUA水平为7.2（2.6）mg/dl。36%为女性，29%患有痛风。中位[四分位间距]CFR降低至1.6[1.2,2.0]，中位[四分位间距]应激MBF为1.5[1.1,2.1]ml/min/g。在调整分析中，SUA与应激MBF呈负相关（β=-0.14，p=0.01），但与CFR无关。在无糖尿病患者（n=215）中，调整年龄、性别、心肌瘢痕和缺血程度、血清肌酐和痛风后，SUA与CFR（β=-0.15，p=0.02）和应激MBF（β=-0.19，p=0.01）呈负相关。在糖尿病患者（n=167）中，SUA与CFR或MBF均无关联。
结论
在这项横断面研究中，较高的SUA与无糖尿病患者中较差的CFR和应激MBF存在适度关联。
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