内皮功能障碍与自发性冠状动脉夹层无关。
Endothelial Dysfunction Is Not Associated With Spontaneous Coronary Artery Dissection.
机构信息
Rambam Medical Center, Department of Cardiology, Haifa, Israel.
Western University, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.
出版信息
Cardiovasc Revasc Med. 2020 Dec;21(12):1539-1541. doi: 10.1016/j.carrev.2020.05.029. Epub 2020 May 23.
BACKGROUND
Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome, yet its pathophysiology is only partially understood. We sought to assess the association between endothelial dysfunction (ED) and SCAD.
METHODS
We prospectively assessed patients presenting with acute coronary syndrome who were diagnosed with SCAD. The control arm had established coronary artery atherosclerotic disease (AD) according to previous coronary angiography. ED was assessed using the EndoPAT 2000 while patients returned to their steady state condition. A total of 16 patients with SCAD and 66 patients with AD were included.
RESULTS
Microvascular reactivity as assessed with the EndoPAT was significantly worse in the AD group compared to the SCAD group. The median RHI in the AD group was 1.76 (IQR 1.52, 2.2) vs. a median RHI of 2.08 (IQR 1.73, 2.79) in the SCAD group (p < 0.05). While the RHI values in half of the AD group (33 patients; 50%) were below the cut-off of 1.67 only one patient had an RHI below this cut-off in the SCAD group.
CONCLUSIONS
Patients with SCAD were not found to have ED and it is therefore unlikely that ED takes part in SCAD formation.
背景
自发性冠状动脉夹层（SCAD）是急性冠状动脉综合征的一个重要病因，但它的病理生理学机制仅部分被了解。我们试图评估内皮功能障碍（ED）与 SCAD 之间的相关性。
方法
我们前瞻性评估了诊断为 SCAD 的急性冠状动脉综合征患者。对照组为根据先前的冠状动脉造影确诊为有冠状动脉粥样硬化性疾病（AD）的患者。在患者恢复稳定状态时，使用 EndoPAT 2000 评估 ED。共纳入 16 例 SCAD 患者和 66 例 AD 患者。
结果
与 SCAD 组相比，AD 组的微血管反应性（通过 EndoPAT 评估）显著更差。AD 组的中位 RHI 为 1.76（IQR 1.52，2.2），而 SCAD 组的中位 RHI 为 2.08（IQR 1.73，2.79）（p < 0.05）。虽然 AD 组有一半（33 例；50%）的 RHI 值低于 1.67 的截止值，但只有 1 例 SCAD 患者的 RHI 值低于该截止值。
结论
SCAD 患者并未发现 ED，因此 ED 不太可能参与 SCAD 的形成。
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