冠状动脉造影患者血管损伤与左心室向心性重构的关系：一项多中心前瞻性研究。

Relationship between vascular damage and left ventricular concentric geometry in patients undergoing coronary angiography: a multicenter prospective study.

机构信息

Internal Medicine, University of Brescia & Spedali Civili Brescia.

Department Scienze della Salute, Bicocca University, Milan.

出版信息

J Hypertens. 2019 Jun;37(6):1183-1190. doi: 10.1097/HJH.0000000000002052.

DOI:10.1097/HJH.0000000000002052

PMID:30882598

Abstract

BACKGROUND

Vascular structural (intima-media thickness) and functional (carotid pulse wave velocity, cPWV) alterations are related to different patterns of left ventricular (LV) geometry in general population samples and in hypertensive patients. The relationship between vascular damage, evaluated by both echotracking ultrasound and coronary angiography, and LV geometry has not been prospectively analyzed.

METHODS

In eight Italian centers, 399 consecutive patients, without history of prior coronary artery disease and with clinical indication to coronary angiography, prospectively underwent cardiac standard ultrasound examination for the evaluation of LV mass, indexed by height to 2.7 power (LVMi g/m) and relative wall thickness (RWT), the measurement of Doppler flow in the left anterior descending artery (LAD) and the echocardiographic calcium score (eCS). In all patients measurement of common carotid intima-media thickness (cIMT) and cPWV by carotid ultrasound, with the realtime echotracking system was performed. The noninvasive evaluations were performed blindly to clinical information, before coronary angiography.

RESULTS

cIMT and cPWV were higher in patients with concentric LV hypertrophy (LVH) (LVMi ≥ 49 g/m in men and ≥47 g/m in women and RWT ≥ 0.42) as compared with those with normal LVMi and geometry (N: LVMi < 49 g/m in men and <47 g/m in women and RWT < 0.42) and to those with concentric remodeling (normal LVMi and RWT ≥ 0.42). Distal LAD velocity and eCS were greater in patients with concentric LVH than in others groups. At coronary angiography the prevalence of coronary stenosis (>50%) was greater in patients with concentric LVH and concentric remodeling, as compared with N. Patients with both concentric LVH and concentric remodeling showed higher values of cIMT and cPWV and distal LAD velocity and a greater prevalence of coronary stenosis (>50%) than patients with RWT less than 0.42.

CONCLUSION

Our results further reinforced the observation that in patients undergoing elective coronary angiography, concentric geometry is associated with structural and functional carotid alterations, with higher distal LAD flow velocity and eCS. In this large group of patients, concentric geometry is associated with a greater prevalence of coronary stenosis, as assessed by coronary angiography. These results might contribute to explain the greater cardiovascular risk associated with concentric remodeling and LVH.

摘要

背景

血管结构（内膜-中层厚度）和功能（颈动脉脉搏波速度，cPWV）的改变与一般人群样本和高血压患者的不同左心室（LV）几何形状有关。血管损伤的关系，通过超声心动图和冠状动脉造影评估，与 LV 几何形状之间的关系尚未得到前瞻性分析。

方法

在八个意大利中心，399 例连续患者，无先前冠状动脉疾病史，并有临床指征行冠状动脉造影，前瞻性行心脏标准超声检查，评估 LV 质量，通过身高指数 2.7 幂（LVMi/g/m）和相对壁厚度（RWT），左前降支（LAD）的多普勒血流测量和超声心动图钙评分（eCS）。在所有患者中，通过颈动脉超声测量颈总动脉内膜-中层厚度（cIMT）和 cPWV，并使用实时超声心动图跟踪系统进行测量。非侵入性评估在冠状动脉造影前盲于临床信息进行。

结果

与正常 LVMi 和几何形状（N：男性 LVMi<49 g/m，女性 LVMi<47 g/m，RWT<0.42）和同心重构（正常 LVMi 和 RWT≥0.42）的患者相比，同心 LVH（LVMi≥49 g/m 的男性和≥47 g/m 的女性和 RWT≥0.42）患者的 cIMT 和 cPWV 更高。与其他组相比，同心 LVH 患者的远端 LAD 速度和 eCS 更大。在冠状动脉造影中，与 N 相比，同心 LVH 和同心重构患者的冠状动脉狭窄（>50%）患病率更大。与 RWT 小于 0.42 的患者相比，同时具有同心 LVH 和同心重构的患者的 cIMT 和 cPWV 以及远端 LAD 速度更高，冠状动脉狭窄（>50%）的患病率更高。

结论

我们的结果进一步强化了这样一种观察，即在接受选择性冠状动脉造影的患者中，同心几何形状与结构性和功能性颈动脉改变相关，远端 LAD 流速和 eCS 更高。在这一大组患者中，与冠状动脉造影评估的同心重构和 LVH 相比，同心几何形状与更大的冠状动脉狭窄患病率相关。这些结果可能有助于解释与同心重构和 LVH 相关的更大心血管风险。