Anderson T J, Uehata A, Gerhard M D, Meredith I T, Knab S, Delagrange D, Lieberman E H, Ganz P, Creager M A, Yeung A C
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
J Am Coll Cardiol. 1995 Nov 1;26(5):1235-41. doi: 10.1016/0735-1097(95)00327-4.
The relation between endothelium-dependent vasodilator function in the brachial and coronary arteries was determined in the same subjects.
Coronary artery endothelial dysfunction precedes the development of overt atherosclerosis and is important in its pathogenesis. A noninvasive assessment of endothelial function in a peripheral conduit vessel, the brachial artery, was recently described, but the relation between brachial artery function and coronary artery vasodilator function has not been explored.
In 50 patients referred to the catheterization laboratory for the evaluation of coronary artery disease (mean age +/- SD 56 +/- 10 years), the coronary vasomotor response to serial intracoronary infusions of the endothelium-dependent agonist acetylcholine (10(-8) to 10(-6) mol/liter), was studied. Endothelium-dependent vasodilation was also assessed in the brachial artery by measuring the change in brachial artery diameter in response to reactive hyperemia.
Patients with coronary artery endothelial dysfunction manifested as vasoconstriction in response to acetylcholine had significantly impaired flow-mediated vasodilation in the brachial artery compared with that of patients with normal coronary endothelial function (4.8 +/- 5.5% vs. 10.8 +/- 7.6%, p < 0.01). Patients with coronary artery disease also had an attenuated brachial artery vasodilator response compared with that of patients with angiographically smooth coronary arteries (4.5 +/- 4.6% vs. 9.7 +/- 8.1%, p < 0.02). By multivariate analysis, the strongest predictors of reduced brachial dilator responses to flow were baseline brachial artery diameter (p < 0.001), coronary endothelial dysfunction (p = 0.003), the presence of coronary artery disease (p = 0.007) and cigarette smoking (p = 0.016). The brachial artery vasodilator response to sublingual nitroglycerin was independent of coronary endothelial responses or the presence of coronary artery disease. The positive predictive value of abnormal brachial dilation ( < 3%) in predicting coronary endothelial dysfunction is 95%.
This study demonstrated a close relation between coronary artery endothelium-dependent vasomotor responses to acetylcholine and flow-mediated vasodilation in the brachial artery. This noninvasive method may become a useful surrogate in assessing the predisposition to atherosclerosis in patients with cardiac risk factors.
在同一组受试者中确定肱动脉和冠状动脉内皮依赖性血管舒张功能之间的关系。
冠状动脉内皮功能障碍先于明显动脉粥样硬化的发生，且在其发病机制中起重要作用。最近描述了一种对外周导管血管（肱动脉）内皮功能的无创评估方法，但肱动脉功能与冠状动脉血管舒张功能之间的关系尚未得到探讨。
在50名因评估冠状动脉疾病而被转诊至心导管实验室的患者（平均年龄±标准差56±10岁）中，研究了冠状动脉对内皮依赖性激动剂乙酰胆碱（10⁻⁸至10⁻⁶摩尔/升）连续冠状动脉内输注的血管舒缩反应。还通过测量肱动脉直径对反应性充血的变化来评估肱动脉的内皮依赖性血管舒张。
与冠状动脉内皮功能正常的患者相比，冠状动脉内皮功能障碍表现为对乙酰胆碱反应性血管收缩的患者，其肱动脉血流介导的血管舒张明显受损（4.8±5.5%对10.8±7.6%，p<0.01）。与冠状动脉造影显示光滑的患者相比，冠状动脉疾病患者的肱动脉血管舒张反应也减弱（4.5±4.6%对9.7±8.1%，p<0.02）。多因素分析显示，肱动脉对血流舒张反应降低的最强预测因素是基线肱动脉直径（p<0.001）、冠状动脉内皮功能障碍（p = 0.003）、冠状动脉疾病的存在（p = 0.007）和吸烟（p = 0.016）。肱动脉对舌下硝酸甘油的血管舒张反应独立于冠状动脉内皮反应或冠状动脉疾病的存在。肱动脉扩张异常（<3%）预测冠状动脉内皮功能障碍的阳性预测值为95%。
本研究表明冠状动脉对乙酰胆碱的内皮依赖性血管舒缩反应与肱动脉血流介导的血管舒张之间存在密切关系。这种无创方法可能成为评估有心脏危险因素患者动脉粥样硬化易感性的有用替代方法。
