Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall Estate, Near Loughborough, Nottinghamshire LE12 5QW, United Kingdom of Great Britain and Northern Ireland; The Academic Department of Military Mental Health, King's College London, SE5 9RJ, United Kingdom of Great Britain and Northern Ireland; Faculty of Health & Social Sciences, Bournemouth University, Bournemouth BH1 3LT, United Kingdom of Great Britain and Northern Ireland; Department of Cardiology, University Hospitals Dorset, Poole Hospital, Poole BH15 2JB, United Kingdom of Great Britain and Northern Ireland.
National Heart and Lung Institute, Faculty of Medicine, Imperial College London, SW3 6LR, United Kingdom of Great Britain and Northern Ireland.
Int J Cardiol. 2023 Nov 1;390:131227. doi: 10.1016/j.ijcard.2023.131227. Epub 2023 Jul 30.
The relationship between acute combat-related traumatic injury (CRTI) to coronary flow reserve (CFR) and subclinical cardiovascular risk have not been examined and was the primary aim of this study.
UK combat veterans from the ADVANCE cohort study (UK-Afghanistan War 2003-14) with traumatic limb amputations were compared to injured non-amputees and to a group of uninjured veterans from the same conflict. Subclinical cardiovascular risk measures included fasted blood atherogenic index of plasma (AIP), triglyceride-glucose index (TyG; insulin resistance), the neutrophil-lymphocyte ratio (NLR) and high-sensitivity C-reactive protein (hs-CRP; vascular inflammation), body mass index (BMI) and visceral fat volume (dual-energy X-ray absorptiometry) and 6-min walk distance (6MWD; physical performance). The subendocardial viability ratio (SEVR), to estimate CFR, was calculated using arterial pulse waveform analysis (Vicorder device). In total 1144 adult male combat veterans were investigated, comprising 579 injured (161 amputees, 418 non-amputees) and 565 uninjured men. AIP, TyG, NLR, hs-CRP, BMI, total body fat and visceral fat volume were significantly higher and the SEVR and 6MWD significantly lower in the amputees versus the injured-non-amputees and uninjured groups. The SEVR was lowest in those with above knee and multiple limb amputations. CRTI (ExpB 0.96; 95% CI 0.94-0.98: p < 0.0001) and amputation (ExpB 0.94: 95% CI 0.91-0.97: p < 0.0001) were independently associated with lower SEVR after adjusting for age, rank, ethnicity and time from injury.
CRTI, traumatic amputation and its worsening physical deficit are associated with lower coronary flow reserve and heightened subclinical cardiovascular risk.
急性战斗相关创伤性损伤（CRTI）与亚临床心血管风险之间的关系尚未得到研究，这是本研究的主要目的。
来自 ADVANCE 队列研究（2003-14 年英国阿富汗战争）的英国战斗退伍军人中有创伤性肢体截肢者与受伤非截肢者以及同一冲突中的一组未受伤退伍军人进行了比较。亚临床心血管风险测量包括空腹血浆致动脉粥样硬化指数（AIP）、甘油三酯-葡萄糖指数（TyG；胰岛素抵抗）、中性粒细胞-淋巴细胞比值（NLR）和高敏 C 反应蛋白（hs-CRP；血管炎症）、体重指数（BMI）和内脏脂肪量（双能 X 射线吸收法）和 6 分钟步行距离（6MWD；身体机能）。使用动脉脉搏波分析（Vicorder 设备）计算心内膜下活力比（SEVR），以估计 CFR。共调查了 1144 名成年男性战斗退伍军人，其中包括 579 名受伤者（161 名截肢者，418 名非截肢者）和 565 名未受伤者。与受伤非截肢者和未受伤组相比，截肢者的 AIP、TyG、NLR、hs-CRP、BMI、体脂肪和内脏脂肪量明显较高，SEVR 和 6MWD 明显较低。膝关节以上和多处肢体截肢者的 SEVR 最低。在调整年龄、级别、种族和受伤时间后，CRTI（ExpB 0.96；95%CI 0.94-0.98：p<0.0001）和截肢（ExpB 0.94：95%CI 0.91-0.97：p<0.0001）与较低的 SEVR 独立相关。
CRTI、创伤性截肢及其恶化的身体缺陷与较低的冠状动脉血流储备和较高的亚临床心血管风险相关。
