Nemoto Teruyoshi, Minami Yoshiyasu, Yamaoka-Tojo Minako, Sato Toshimitsu, Muramatsu Yusuke, Kakizaki Ryota, Fujiyoshi Kazuhiro, Hashimoto Takuya, Meguro Kentaro, Shimohama Takao, Tojo Taiki, Ako Junya
Kitasato University Graduate School of Medical Sciences.
Department of Cardiovascular Medicine, Kitasato University School of Medicine.
Int Heart J. 2019 May 30;60(3):539-545. doi: 10.1536/ihj.18-531. Epub 2019 Apr 10.
The association between endothelial function, evaluated using flow-mediated dilatation (FMD), and the severity of coronary artery disease remains to be elucidated.A total of 245 consecutive patients with stable angina were prospectively enrolled. FMD was evaluated in the brachial artery before percutaneous coronary intervention. Patients were divided into 2 groups according to the FMD value (lower FMD group [FMD < 2.0], n = 82; higher FMD group [FMD ≥ 2.0], n = 163). The severity of coronary artery disease was evaluated using findings of angiography and optical coherence tomography, and compared between the 2 groups.The prevalence of left main (LM) disease was significantly higher in the lower FMD group than in the higher FMD group (8.5% versus 2.5%, P = 0.046), although the prevalence of multivessel disease was comparable between the groups. Lower FMD was independently associated with a higher prevalence of LM disease (odds ratio, 3.89; 95% confidence interval, 1.12-15.5; P = 0.033). A general linear model with multiple variables revealed that the minimal lumen area (MLA) in the culprit lesion was significantly smaller in patients with lower FMD than in those with higher FMD (regression coefficient b, -0.249 mm; 95% confidence interval, -0.479--0.018 mm; P = 0.035). The prevalence ofvulnerable plaque characteristics was comparable between the 2 groups.Patients with lower FMD had a higher incidence of LM disease and a smaller MLA in the culprit lesion. FMD may be a useful, noninvasive indicator for identifying patients with severe coronary artery disease.
使用血流介导的血管舒张（FMD）评估的内皮功能与冠状动脉疾病严重程度之间的关联仍有待阐明。前瞻性纳入了连续245例稳定型心绞痛患者。在经皮冠状动脉介入治疗前，对肱动脉进行FMD评估。根据FMD值将患者分为两组（FMD较低组[FMD<2.0]，n = 82；FMD较高组[FMD≥2.0]，n = 163）。使用血管造影和光学相干断层扫描的结果评估冠状动脉疾病的严重程度，并在两组之间进行比较。较低FMD组左主干（LM）疾病的患病率显著高于较高FMD组（8.5%对2.5%，P = 0.046），尽管两组之间多支血管疾病的患病率相当。较低的FMD与LM疾病的较高患病率独立相关（优势比，3.89；95%置信区间，1.12 - 15.5；P = 0.033）。多变量的一般线性模型显示，FMD较低的患者罪犯病变中的最小管腔面积（MLA）显著小于FMD较高的患者（回归系数b，-0.249 mm；95%置信区间，-0.479 - -0.018 mm；P = 0.035）。两组之间易损斑块特征的患病率相当。FMD较低的患者LM疾病的发生率较高，且罪犯病变中的MLA较小。FMD可能是识别严重冠状动脉疾病患者的有用的非侵入性指标。
