Division of Cardiovacular Disease, Hallym University Medical Center, Anyang, Republic of Korea.
Department of Physiology, College of Medicine, Hallym University, Chuncheon, Republic of Korea.
Cardiology. 2021;146(3):281-287. doi: 10.1159/000513141. Epub 2021 Apr 13.
Endothelial dysfunction is a predictor of atherosclerotic cardiovascular disease (ASCVD) and plays an important role in vasospastic angina (VA).
This study evaluated whether flow-mediated dilation (FMD) is also a good marker of 10-year ASCVD risk (10Y-ASCVDR) in patients with VA.
Based on their clinical history and coronary artery diameter stenosis (DS), patients were retrospectively enrolled into VA (DS <50% and positive ergonovine provocation), minor coronary artery disease (mCAD, DS <30%), and significant coronary artery disease (sCAD, DS ≥50%) groups. Endothelial function was evaluated by FMD.
Each group contained 50 patients. The 10Y-ASCVDR was significantly higher in the sCAD group than in the VA and mCAD groups (10.86 ± 7.30, 4.71 ± 4.04, and 4.77 ± 4.30, respectively, p < 0.001). The FMD was significantly higher in the mCAD group than in the VA and sCAD groups (6.37 ± 4.25, 3.10 ± 2.23, and 3.07 ± 1.89, respectively, p < 0.001). A significant correlation was found between the FMD and 10Y-ASCVD in the mCAD group (r = -0.622, p < 0.001) and the sCAD group (r = -0.557, p < 0.001) but not in the VA group (r = -0.193, p = 0.179). After adjusting for potential confounders such as BMI, C-reactive protein, maximal coronary stenosis, and brachial-ankle pulse wave velocity, multivariate analysis showed that FMD was independently associated with 10Y-ASCVDR in all patients. However, when looking only at the VA group, FMD did not correlate independently with 10Y-ASCVDR.
Unlike mCAD and sCAD, we found no correlation between 10Y-ASCVDR and endothelial function in VA. Thus, our results support that FMD is not a good marker of atherosclerotic cardiovascular risk in VA.
内皮功能障碍是动脉粥样硬化性心血管疾病（ASCVD）的预测因子，在血管痉挛性心绞痛（VA）中发挥重要作用。
本研究旨在评估血流介导的舒张功能（FMD）是否也是 VA 患者 10 年 ASCVD 风险（10Y-ASCVDR）的良好标志物。
根据患者的临床病史和冠状动脉直径狭窄（DS），将患者回顾性地分为 VA（DS <50%和阳性麦角新碱激发）、小冠状动脉疾病（mCAD，DS <30%）和大冠状动脉疾病（sCAD，DS ≥50%）组。通过 FMD 评估内皮功能。
每个组均包含 50 名患者。sCAD 组的 10Y-ASCVDR 明显高于 VA 和 mCAD 组（分别为 10.86 ± 7.30、4.71 ± 4.04 和 4.77 ± 4.30，p < 0.001）。mCAD 组的 FMD 明显高于 VA 和 sCAD 组（分别为 6.37 ± 4.25、3.10 ± 2.23 和 3.07 ± 1.89，p < 0.001）。mCAD 组和 sCAD 组的 FMD 与 10Y-ASCVD 之间存在显著相关性（r = -0.622，p < 0.001；r = -0.557，p < 0.001），但 VA 组无相关性（r = -0.193，p = 0.179）。在校正 BMI、C 反应蛋白、最大冠状动脉狭窄和臂踝脉搏波速度等潜在混杂因素后，多变量分析表明，FMD 与所有患者的 10Y-ASCVDR 独立相关。然而，仅观察 VA 组时，FMD 与 10Y-ASCVDR 无独立相关性。
与 mCAD 和 sCAD 不同，我们发现 VA 中 10Y-ASCVDR 与内皮功能之间无相关性。因此，我们的结果支持 FMD 不是 VA 中 ASCVD 风险的良好标志物。
