From the Department of Internal Medicine (R.M.B., J.D.T., S.M., C.L.J., T.O., A.A., A.T., C.Y.L., B.R.S., R.S.R.), University of Utah, Salt Lake City.
Geriatric Research, Education, and Clinical Center, Salt Lake City VAMC (R.M.B., J.D.T., C.L.J., R.S.R.).
Hypertension. 2019 Jul;74(1):208-215. doi: 10.1161/HYPERTENSIONAHA.119.12881. Epub 2019 May 6.
Early detection of coronary artery dysfunction is of paramount cardiovascular clinical importance, but a noninvasive assessment is lacking. Indeed, the brachial artery flow-mediated dilation test only weakly correlated with acetylcholine-induced coronary artery function ( r=0.36). However, brachial artery flow-mediated dilation methodologies have, over time, substantially improved. This study sought to determine if updates to this technique have improved the relationship with coronary artery function and the noninvasive indication of coronary artery dysfunction. Coronary artery and brachial artery function were assessed in 28 patients referred for cardiac catheterization (61±11 years). Coronary artery function was determined by the change in artery diameter with a 1.82 μg/min intracoronary acetylcholine infusion. Based on the change in vessel diameter, patients were characterized as having dysfunctional coronary arteries (>5% vasoconstriction) or relatively functional coronary arteries (<5% vasoconstriction). Brachial artery function was determined by flow-mediated dilation, adhering to current guidelines. The acetylcholine-induced change in vessel diameter was smaller in patients with dysfunctional compared with relatively functional coronary arteries (-11.8±4.6% versus 5.8±9.8%, P<0.001). Consistent with this, brachial artery flow-mediated dilation was attenuated in patients with dysfunctional compared with relatively functional coronaries (2.9±1.9% versus 6.2±4.2%, P=0.007). Brachial artery flow-mediated dilation was strongly correlated with the acetylcholine-induced change in coronary artery diameter ( r=0.77, P<0.0001) and was a strong indicator of coronary artery dysfunction (receiver operator characteristic=78%). The current data support that updates to the brachial artery flow-mediated dilation technique have strengthened the relationship with coronary artery function, which may now provide a clinically meaningful indication of coronary artery dysfunction.
早期发现冠状动脉功能障碍对心血管临床具有至关重要的意义，但目前缺乏非侵入性评估方法。实际上，肱动脉血流介导的扩张试验仅与乙酰胆碱诱导的冠状动脉功能呈弱相关（r=0.36）。然而，肱动脉血流介导的扩张方法随着时间的推移已经得到了实质性的改进。本研究旨在确定该技术的更新是否改善了与冠状动脉功能的关系，以及是否为冠状动脉功能障碍提供了非侵入性的指征。对 28 例因心脏导管插入术而就诊的患者（61±11 岁）进行了冠状动脉和肱动脉功能评估。冠状动脉功能通过 1.82μg/min 冠状动脉内乙酰胆碱输注引起的动脉直径变化来确定。根据血管直径的变化，患者被分为冠状动脉功能障碍（>5%血管收缩）或相对功能正常的冠状动脉（<5%血管收缩）。肱动脉功能通过血流介导的扩张来确定，符合当前的指南。与相对功能正常的冠状动脉相比，功能障碍的冠状动脉患者的乙酰胆碱诱导的血管直径变化较小（-11.8±4.6%比 5.8±9.8%，P<0.001）。与此一致，与相对功能正常的冠状动脉相比，功能障碍的冠状动脉患者的肱动脉血流介导的扩张减弱（2.9±1.9%比 6.2±4.2%，P=0.007）。肱动脉血流介导的扩张与乙酰胆碱诱导的冠状动脉直径变化呈强相关（r=0.77，P<0.0001），是冠状动脉功能障碍的强有力指标（受试者工作特征=78%）。目前的数据支持，肱动脉血流介导的扩张技术的更新加强了与冠状动脉功能的关系，这可能为冠状动脉功能障碍提供了有临床意义的指征。
