脉搏波速度与冠状动脉血流速度储备的相关性

Correlation of large artery stiffness and coronary flow vdocity reserve

目的探讨冠心病易患因素患者的大动脉僵硬度与冠状动脉血流速度储备（CFVR）之间的相关性。方法入选无明确冠心病但存在冠心病易患因素患者101例，检测踝臂脉搏波速度（baPWV），以baPWV1400cm／s为界点，将研究对象分为〈1400cm／s组和〉1400cm／s组。应用经胸超声心动图法检测研究对象基线状态时冠状动脉左前降支（LAD）血流，以及静脉输注腺苷后测得血管最大程度扩张时LAD的血流，冠状动脉最大程度扩张时的血流量与静息状态下血流量的比值即为CFVR。结果baPWV〉1400cm／s组的年龄、高血压及糖尿病明显高于baPWV〈1400cm／s组，提示年龄、高血压和糖尿病在血管硬化中的促进作用。baPWV〉1400cm／s组CFVR水平显著低于baPWV〈1400cm／s组（2．66±0．74比2．95±0．76；P〈0．01）。相关性分析显示，CFVR与baPWV水平呈显著负相关（r=-0．35，P〈0．01）。本试验中，baPWV水平最高者2314cm／s，测得的CFVR为2．32；baPWV水平最低者1066cm／s，其CFVR为3．1。结论血管僵硬度的增加可能损害且同时伴随冠状动脉内皮功能及冠脉微循环障碍，进而增加不良心血管事件的风险。

Objective Coronary flow velocity reserve （CFVR） is an important indicator of coronary endothelial functions and microcireu]ation. Pulse wave velocity （PWV） reflects the degree of aortic sclerosis and it is an independent predictor of cardiovascular events. The present study was designed to evaluate the correlation of large artery stiffness and CFVR. Methods A total of 101 consecutive subjects were enrolled to measure the brachial-ankle pulse wave velocity （baPWV）. According to the presence or absence of higher baPWV （ 〉 1400 cm/s）, they were divided into 2 groups. Transthoracic echocardiagraphy was employed to measure coronary flow velocity in coronary left anterior descending （LAD）. Then after an intravenous infusion of adenosine triphosphate, the velocity of blood flow was measured when the vessel was in maximal dilation. The ratio of flow velocity of those in maximal dilation to those at rest was CFVR. Results The subjects with a higher baPWV （ 〉 1400 cm/s） were markedly elder and had higher risks of hypertension and diabetes. Thus age, hypertension and diabetes contributed to arteriosclerosis. More importantly, the subjects with a higher baPWV （ 〉 1400 cm/s） had a much lower level of CFVR（2. 66 -sO. 74vs 2.95 -sO. 76; P 〈 0. 01 ）than those with a lower baPWV （ 〈 1400 cm/s）. Furthermore correlation analysis showed that CFVR and baPWV levels were significantly negatively correlated （ r = - 0. 35, P 〈 0. O1 ）. Conclusions A negative correlation exists between artery stiffness and coronary flow velocity reserve. The increased vascular stiffness may impair coronary endothelial function, cause the dysfunction of coronary microcirculation and raise the risks of cardiovascular events.