采用脉搏波速度和增强指数检测动脉僵硬度在抗磷脂综合征心血管风险分层中的应用。
Arterial stiffness tested by pulse wave velocity and augmentation index for cardiovascular risk stratification in antiphospholipid syndrome.
机构信息
First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
出版信息
Rheumatology (Oxford). 2024 Apr 2;63(4):1030-1038. doi: 10.1093/rheumatology/kead267.
OBJECTIVES
Cardiovascular disease is a major cause of morbidity and mortality in Antiphospholipid syndrome (APS). Arterial stiffness (ArS) has emerged as a predictor of future cardiovascular events in the general population. We aimed to assess ArS in patients with thrombotic APS versus diabetes mellitus (DM) and healthy controls (HC) and identify predictors of increased ArS in APS.
METHODS
ArS was evaluated by carotid-femoral pulse wave velocity (cfPWV) and augmentation index normalized to 75 beats/min (AIx@75) using the SphygmoCor device. Participants also underwent carotid/femoral ultrasound for atherosclerotic plaque detection. We used linear regression to compare ArS measures among groups and assess ArS determinants in the APS group.
RESULTS
We included 110 patients with APS (70.9% female, mean age 45.4 years), 110 DM patients and 110 HC, all age/sex matched. After adjustment for age, sex, cardiovascular risk factors and plaque presence, APS patients exhibited similar cfPWV [β = -0.142 (95% CI -0.514, 0.230), p = 0.454] but increased AIx@75 [β = 4.525 (95% CI 1.372, 7.677), p = 0.005] compared with HC and lower cfPWV (p < 0.001) but similar AIx@75 (p = 0.193) versus DM patients. In the APS group, cfPWV was independently associated with age [β = 0.056 (95% CI 0.034, 0.078), p < 0.001], mean arterial pressure (MAP) [β = 0.070 (95% CI 0.043, 0.097), p < 0.001], atherosclerotic femoral plaques [β = 0.732 (95% CI 0.053, 1.411), p = 0.035] and anti-β2-glycoprotein I IgM positivity [β = 0.696 (95% CI 0.201, 1.191), p = 0.006]. AIx@75 was associated with age [β = 0.334 (95% CI 0.117, 0.551), p = 0.003], female sex [β = 7.447 (95% CI 2.312, 12.581), p = 0.005] and MAP [β = 0.425 (95% CI 0.187, 0.663), p = 0.001].
CONCLUSION
APS patients exhibit elevated AIx@75 vs HC and similar to DM patients, indicating enhanced arterial stiffening in APS. Given its prognostic value, ArS evaluation may help to improve cardiovascular risk stratification in APS.
目的
心血管疾病是抗磷脂综合征（APS）患者发病和死亡的主要原因。动脉僵硬度（ArS）已成为一般人群未来心血管事件的预测指标。本研究旨在评估血栓性 APS 患者的 ArS 与糖尿病（DM）患者和健康对照组（HC）的差异，并确定 APS 患者 ArS 升高的预测因素。
方法
使用 SphygmoCor 设备评估颈动脉-股动脉脉搏波速度（cfPWV）和归一化至 75 次/分的增强指数（AIx@75）以评估 ArS。参与者还接受了颈动脉/股动脉超声检查以检测动脉粥样硬化斑块。我们使用线性回归比较各组之间的 ArS 指标，并评估 APS 组中 ArS 的决定因素。
结果
我们纳入了 110 名 APS 患者（70.9%为女性，平均年龄 45.4 岁）、110 名 DM 患者和 110 名 HC，所有患者均按年龄和性别匹配。在校正年龄、性别、心血管危险因素和斑块存在后，APS 患者的 cfPWV 相似[β=-0.142（95%CI -0.514，0.230），p=0.454]，但 AIx@75 较高[β=4.525（95%CI 1.372，7.677），p=0.005]，与 HC 相比，cfPWV 较低（p<0.001），但 AIx@75 与 DM 患者相似（p=0.193）。在 APS 组中，cfPWV 与年龄[β=0.056（95%CI 0.034，0.078），p<0.001]、平均动脉压（MAP）[β=0.070（95%CI 0.043，0.097），p<0.001]、股动脉粥样硬化斑块[β=0.732（95%CI 0.053，1.411），p=0.035]和抗β2-糖蛋白 I IgM 阳性[β=0.696（95%CI 0.201，1.191），p=0.006]独立相关。AIx@75 与年龄[β=0.334（95%CI 0.117，0.551），p=0.003]、女性[β=7.447（95%CI 2.312，12.581），p=0.005]和 MAP[β=0.425（95%CI 0.187，0.663），p=0.001]相关。
结论
与 HC 相比，APS 患者的 AIx@75 升高，与 DM 患者相似，表明 APS 患者的动脉僵硬度增强。鉴于其预后价值，ArS 评估可能有助于改善 APS 的心血管风险分层。
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