Neunteufl T, Katzenschlager R, Hassan A, Klaar U, Schwarzacher S, Glogar D, Bauer P, Weidinger F
Department of Cardiology/Second Medical Department, University of Vienna Medical School, Austria.
Atherosclerosis. 1997 Feb 28;129(1):111-8. doi: 10.1016/s0021-9150(96)06018-2.
Flow-mediated vasodilation (FMD) of systemic arteries, a non-invasive parameter of endothelial function, is correlated with cardiovascular risk factors. The relationship between FMD and morphologically and clinically evident coronary artery disease has not been described. This study was performed to test the hypothesis that an impairment of FMD in the brachial artery is related to the presence and/or extent and severity of coronary artery disease (CAD). We examined 74 patients with angina pectoris and 14 control subjects (age 17 36 years). Angiography revealed coronary artery disease (> or = 30% diameter stenosis) in 44 patients (CAD, age 32 67 years) and smooth coronary arteries in 30 patients (non-CAD, age 22-73 years). Vasodilation following reactive hyperemia and after sublingual nitroglycerin (NTG) was assessed in the brachial artery using B-mode high resolution ultrasound. CAD patients showed markedly impaired FMD compared to the non-CAD group (5.7 +/- 4.8 versus 12.6 +/- 6.7%, P < 0.0001) and to controls (5.7 +/- 4.8 versus 15.7 +/- 3.9%, P < 0.00001). NTG induced similar degrees of vasodilation in the CAD and non-CAD groups but less vasodilation in the CAD patients compared to controls (12.2 +/- 6.3 versus 20.4 +/- 6.9%, P < 0.01). On univariate analysis, impaired FMD in CAD patients and non-CAD patients was related to the extent of coronary disease (1-, 2- or 3-vessel disease; r = -0.67, P < 0.0001), to the maximum percent diameter stenosis in one of the major coronary vessels (r = -0.52, P < 0.0001), brachial artery diameter (r = -0.46, P < 0.0001) and plasma cholesterol level (r = -0.34, P < 0.001). On multiple stepwise regression analysis the extent of coronary disease (r = -0.51, P < 0.0001) and the baseline brachial artery diameter (r = -0.37, P < 0.0001) were independently associated with FMD in CAD and non-CAD patients. The present findings suggest that the impairment of FMD in the brachial artery, a marker of systemic endothelial function, is closely related to the angiographic extent of CAD.
全身动脉的血流介导的血管舒张功能（FMD）是内皮功能的一项非侵入性指标，与心血管危险因素相关。FMD与形态学及临床明显的冠状动脉疾病之间的关系尚未见描述。本研究旨在验证肱动脉FMD受损与冠状动脉疾病（CAD）的存在、范围及严重程度相关这一假设。我们检查了74例心绞痛患者和14例对照者（年龄17 - 36岁）。血管造影显示44例患者存在冠状动脉疾病（直径狭窄≥30%，CAD组，年龄32 - 67岁），30例患者冠状动脉正常（非CAD组，年龄22 - 73岁）。使用B型高分辨率超声评估肱动脉在反应性充血及舌下含服硝酸甘油（NTG）后的血管舒张情况。与非CAD组相比（5.7±4.8%对12.6±6.7%，P<0.0001）以及与对照组相比（5.7±4.8%对15.7±3.9%，P<0.00001），CAD患者的FMD明显受损。NTG在CAD组和非CAD组诱导的血管舒张程度相似，但与对照组相比，CAD患者的血管舒张程度较小（12.2±6.3%对20.4±6.9%，P<0.01）。单因素分析显示，CAD患者和非CAD患者的FMD受损与冠状动脉疾病的范围（单支、双支或三支血管病变；r = -0.67，P<0.0001）、主要冠状动脉之一的最大直径狭窄百分比（r = -0.52，P<0.0001）、肱动脉直径（r = -0.46，P<0.0001）及血浆胆固醇水平（r = -0.34，P<0.001）相关。多因素逐步回归分析显示，冠状动脉疾病的范围（r = -0.51，P<0.0001）和基线肱动脉直径（r = -0.37，P<0.0001）在CAD患者和非CAD患者中与FMD独立相关。目前的研究结果提示，肱动脉FMD受损作为全身内皮功能的一个指标，与CAD的血管造影范围密切相关。
