Comparable Prognostic Value of Vasodilator Response to Acetylcholine in Brachial and Coronary Arteries for Predicting Long-Term Cardiovascular Events in Suspected Coronary Artery Disease

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概要

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• Background Vasodilator response to acetylcholine (ACh)(ie, endothelium-dependent dilation) is impaired in the peripheral and coronary circulation of patients with coronary risk factors and coronary artery disease (CAD). There is a close relationship of vasodilator response to ACh in both the coronary artery (CA) and the brachial artery (BA), but the comparative prognostic importance of these responses has not been fully investigated in relatively low-risk suspected CAD. Methods and Results The flow responses of both the CA and BA were measured in 70 patients with suspected CAD, excluding patients with triple-vessel disease and known peripheral or cerebrovascular disorders. A Doppler guidewire was placed into a major branch of the CA and a proximal portion of the left BA. ACh was infused at 10^<-8>, 10^<-7> and 10^<-6> mol/L for 3 min into the CA and at 7.5, 15, and 30μg/min for 5 min into BA. The flow response was obtained by multiplying the average peak velocity by the cross-sectional area from quantitative angiography. Vasodilator response to ACh was assessed by the ratio of ACh-induced flow/baseline flow, expressed as coronary blood flow index (CBFI) or brachial blood flow index (BBFI). There were 39 CAD patients (61±8 years old) and 31 normal coronary patients (NL, 58±11 years old) who were followed up for 53±17 months. Eleven patients had coronary events (CE) during this period : 1 case of nonfatal myocardial infarction and 10 cases of unstable angina. A strong correlation between CBFI and BBFI was observed at middle- and high-doses of ACh (r=0.72, p<0.0001, 15μg/min vs 10^<-7> mol/L; r=0.76, p<0.0001, 30μg/min vs 10^<-6> mol/L). Kaplan-Meier analysis, using the best cut-off values obtained from receiver-operating characteristic curves for CE, revealed that both CBFI and CAFI were significant predictors for CE. Conclusions The BA vasodilator response to optimal ACh dosage can be used as a surrogate prognostic predictor for coronary endothelial function tests in patients with suspected CAD.

• 社団法人日本循環器学会の論文
• 2005-12-20

著者

• Ishihara Masayuki

  National Defense Medical College Research Institute, Division of Biomedical Engineering

• Kurita Akira

  National Defense Medical College Research Institute, Division of Biomedical Engineering

• Ohsuzu Fumitaka

  National Defense Medical College, IInternal Medicine-1

• Takase Bonpei

  National Defense Medical College

• SATOMURA Kimio

  National Defense Medical College

• UEHATA Akimi

  National Defense Mediccal College, Department of Internal Medicine-1

• Satomura Kimio

  National Defense Medical College Research Institute Division Of Biomedical Engineering And Internal

• Satomura Kimio

  Internal Medicine I National Defense Medical College

• Hamabe Akira

  Self Defense Forces Central Hospital Internal Medicine

• Hara Akiko

  Iruma Heart Hospital

• Uehata Akimi

  Self Defense Forces Central Hospital, Internal Medicine

• Hamabe Akira

  National Defense Medical College Research Institute

• Akima Takasi

  National Defense Medical College Research Institute, Division of Biomedical Engineering and Internal

• Matsui Takemi

  National Defense Medical College Research Institute, Division of Biomedical Engineering and Internal

• Kurita Akira

  National Defense Medical College Research Institute Division Of Biomedical Engineering

• Matsui Takemi

  Faculty Of System Design Tokyo Metropolitan University

• Takase Bonpei

  National Defense Medical College Department Of Intensive Care Medicine

• Ohsuzu Fumitaka

  Department Of Internal Medicine National Defense Medical College

• Osuzu Fumitaka

  First Department Of Internal Medicine National Defence Medical Collage

• Ohsuzu Fumitaka

  National Defense Medical College

• Akima Takashi

  Department Of Pathology And Laboratory Medicine National Defense Medical College

• Ishihara Masayuki

  National Defense Medical Collage Research Institute Division Of Biomedical Engineering

• Uehata Akimi

  Self Defense Forces Central Hospital Internal Medicine

• Matsui Takemi

  Research Institute Research Institute National Defense Medical College

• Ohsuzu Fumitaka

  First Department Of Internal Medicine National Defence Medical Collage

• Hara Akiko

  Self Defense Forces Central Hospital

• Kurita Akira

  Research Institute National Defense Medical College

• Uehata Akimi

  Self Defense Forces Central Hospital

• Ohsuzu Fumitaka

  First Department Of Internal Medicine And The First Department Of Anatomy National Defense Medical C

• Takase Bonpei

  Department Of Intensive Care Medicine National Defense Medical College

• Kurita Akira

  Division Of Biomedical Engineering Research Institute National Defense Medical College

• Ishihara M

  National Defence Medical Coll. Saitama

• Satomura Kimio

  First Department Of Internal Medicine National Defense Medical College

• Takase Bonpei

  National Defense Medical College Research Institute

• Satomura Kimio

  First Department Of Internal Medicine And The First Department Of Anatomy National Defense Medical C

• Matsui Takemi

  National Defense Medical College Research Institute Division Of Biomedical Engineering And Internal

• Ishihara Masayuki

  Division Of Biomedical Engineering National Defense Medical College Research Institute

• Akima Takashi

  First Department Of Internal Medicine National Defense Medical College

• Kameyama Akira

  First Department Of Internal Medicine National Defense Medical College

• Satomura Kirnio

  First Department Of Internal Medicine And The First Department Of Anatomy National Defense Medical C

• Ishihara Masayuki

  National Defence Medical College Research Institute Division Of Biomedical Engineering

• Satomura Kimio

  First Department Of Internal Medicine And The First Department Of Anatomy National Defense Medical C

• Ishihara Masayuki

  National Defense Medical College

• Uehata Akimi

  Department Of Cardiology Self Defense Central Hospital

• Hamabe Akira

  National Defense Medical College Internal Medicine-1

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