Maruhashi Tatsuya, Kajikawa Masato, Kishimoto Shinji, Yamaji Takayuki, Harada Takahiro, Hashimoto Yu, Mizobuchi Aya, Tanigawa Shunsuke, Yusoff Farina Mohamad, Nakano Yukiko, Chayama Kazuaki, Nakashima Ayumu, Goto Chikara, Higashi Yukihito
Department of Regenerative Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan.
Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan.
Hypertens Res. 2024 Feb;47(2):281-290. doi: 10.1038/s41440-023-01442-4. Epub 2023 Oct 4.
The percentage of mean arterial pressure (%MAP) is the height of the mean arterial waveform divided by the peak amplitude of the waveform of pulse volume recording. The purpose of this study was to determine whether the cutoff value of 45% for %MAP at the ankle, which is recommended for the diagnosis of lower extremity artery disease, in combination with ankle-brachial index (ABI) is useful for detecting patients with clinical coronary artery disease (CAD) and investigate the optimal cutoff value of %MAP to diagnose patients with CAD. We measured ABI and %MAP in 2213 subjects (mean age: 61.2 ± 15.5 years). Multivariate analysis revealed that %MAP ≥ 45% was significantly associated with a higher risk of CAD after adjusting for traditional cardiovascular risk factors (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.43-3.21; p < 0.001). However, the association was no longer significant after adjusting for ABI (OR, 1.39; 95% CI, 0.83-2.33; p = 0.21), whereas ABI was significantly associated with CAD (OR, 0.98; 95% CI, 0.97-0.99; p = 0.005). The optimal cutoff value of %MAP derived from a receiver operating characteristic curve to diagnose CAD was 40.3%. Multivariate analysis revealed that %MAP ≥ 40.3% was significantly associated with a higher risk of CAD (OR, 1.63; 95% CI, 1.19-2.24; p = 0.002) independent of ABI (OR, 0.98; 95% CI, 0.97-0.99; p = 0.002). The cutoff value of 40.3%, but not 45%, for %MAP may be useful for detecting patients with advanced atherosclerosis and for cardiovascular risk assessment independent of ABI. REGISTRATION INFORMATION: http://www.umin.ac.jp (University Hospital Medical Information Network Clinical Trials Registry) (UMIN000039512).
平均动脉压百分比（%MAP）是平均动脉波形的高度除以脉搏容积记录波形的峰值幅度。本研究的目的是确定用于诊断下肢动脉疾病的推荐的踝部%MAP临界值45%，结合踝臂指数（ABI）是否有助于检测临床冠状动脉疾病（CAD）患者，并研究诊断CAD患者的%MAP最佳临界值。我们测量了2213名受试者（平均年龄：61.2±15.5岁）的ABI和%MAP。多变量分析显示，在调整传统心血管危险因素后，%MAP≥45%与CAD风险较高显著相关（比值比[OR]，2.14；95%置信区间[CI]，1.43 - 3.21；p<0.001）。然而，在调整ABI后，这种关联不再显著（OR，1.39；95%CI，0.83 - 2.33；p = 0.21），而ABI与CAD显著相关（OR，0.98；95%CI，0.97 - 0.99；p = 0.005）。从诊断CAD的受试者工作特征曲线得出的%MAP最佳临界值为40.3%。多变量分析显示，%MAP≥40.3%与CAD风险较高显著相关（OR，1.63；95%CI，1.19 - 2.24；p = 0.002），独立于ABI（OR，0.98；95%CI，0.97 - 0.99；p = 0.002）。%MAP的40.3%临界值而非45%临界值可能有助于检测晚期动脉粥样硬化患者并进行独立于ABI的心血管风险评估。注册信息：http://www.umin.ac.jp（大学医院医学信息网络临床试验注册中心）（UMIN000039512）。
