Zhu Bin, Wu Qiuwen, Yan Kunlei, Liu Gang, Jia Haibo, Hu Sining, Wang Fan, Meng Wei, Zeng Ming, Chen Xi, Yu Bo, Zhang Shuo
Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, 150086 Harbin, Heilongjiang, China.
The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, 150086 Harbin, Heilongjiang, China.
Rev Cardiovasc Med. 2024 Mar 28;25(4):123. doi: 10.31083/j.rcm2504123. eCollection 2024 Apr.
Endothelial dysfunction, characterized by impaired flow-mediated vasodilation (FMD), is associated with atherosclerosis. However, the relationship between FMD, plaque morphology, and clinical outcomes in patients with acute coronary syndrome (ACS) remains underexplored. This study aims to investigate the influence of FMD on the morphology of culprit plaques and subsequent clinical outcomes in patients with ACS.
This study enrolled 426 of 2482 patients who presented with ACS and subsequently underwent both preintervention FMD and optical coherence tomography (OCT) between May 2020 and July 2022. Impaired FMD was defined as an FMD% less than 7.0%. Major adverse cardiac events (MACEs) included cardiac death, nonfatal myocardial infarction, revascularization, or rehospitalization for angina.
Within a one-year follow-up, 34 (8.0%) patients experienced MACEs. The median FMD% was 4.0 (interquartile range 2.6-7.0). Among the patients, 225 (52.8%) were diagnosed with plaque rupture (PR), 161 (37.8%) with plaque erosion (PE), and 25 (5.9%) with calcified nodules (CN). Impaired FMD was found to be associated with plaque rupture (odds ratio [OR] = 4.22, 95% confidence interval [CI]: 2.07-6.72, = 0.012) after adjusting for potential confounding factors. Furthermore, impaired FMD was linked to an increased incidence of MACEs (hazard ratio [HR] = 3.12, 95% CI: 1.27-6.58, = 0.039).
Impaired FMD was observed in three quarters of ACS patients and can serve as a noninvasive predictor of plaque rupture and risk for future adverse cardiac outcomes.
以内皮功能障碍为特征的血流介导的血管舒张（FMD）受损与动脉粥样硬化相关。然而，急性冠状动脉综合征（ACS）患者中FMD、斑块形态和临床结局之间的关系仍未得到充分研究。本研究旨在探讨FMD对ACS患者罪犯斑块形态及后续临床结局的影响。
本研究纳入了2482例因ACS就诊的患者中的426例，这些患者于2020年5月至2022年7月期间在干预前均接受了FMD和光学相干断层扫描（OCT）检查。FMD受损定义为FMD%小于7.0%。主要不良心脏事件（MACE）包括心源性死亡、非致命性心肌梗死、血运重建或因心绞痛再次住院。
在一年的随访期内，34例（8.0%）患者发生了MACE。FMD%的中位数为4.0（四分位间距2.6 - 7.0）。在这些患者中，225例（52.8%）被诊断为斑块破裂（PR），161例（37.8%）为斑块侵蚀（PE），25例（5.9%）为钙化结节（CN）。在调整潜在混杂因素后，发现FMD受损与斑块破裂相关（比值比[OR]=4.22，95%置信区间[CI]：2.07 - 6.72，P = 0.012）。此外，FMD受损与MACE发生率增加相关（风险比[HR]=3.12，95% CI：1.27 - 6.58，P = 0.039）。
四分之三的ACS患者存在FMD受损，其可作为斑块破裂及未来不良心脏结局风险的无创预测指标。
