Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease

被引:2084
|
作者
Schächinger, V [1 ]
Britten, MB [1 ]
Zeiher, AM [1 ]
机构
[1] Goethe Univ Frankfurt, Div Cardiol, Dept Internal Med 4, D-60590 Frankfurt, Germany
关键词
coronary disease; endothelium; prognosis; acetylcholine; myocardial infarction;
D O I
10.1161/01.CIR.101.16.1899
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-Endothelial vasodilator dysfunction is a characteristic feature of patients at risk for coronary atherosclerosis. Therefore, we prospectively investigated whether coronary endothelial dysfunction predicts disease progression and cardiovascular event rates. Methods and Results-Coronary vasoreactivity was assessed in 147 patients using the endothelium-dependent dilator acetylcholine, sympathetic activation by cold presser testing, dilator responses to increased blood flow, and dilation in response to nitroglycerin. Cardiovascular events (cardiovascular death, unstable angina, myocardial infarction, percutaneous transluminal coronary angioplasty, coronary bypass grafting, ischemic stroke, or peripheral artery revascularization) served as outcome variables over a median follow-up period of 7.7 years. Patients suffering from cardiovascular events during follow-up (n=16) had significantly increased vasoconstrictor responses to acetylcholine infusion (P=0.009) and cold presser testing (P=0.002), as well as significantly blunted vasodilator responses to increased blood flow (P<0.001) and the intracoronary injection of nitroglycerin (P=0.001). Impaired endothelial and endothelium-independent coronary vasoreactivity were associated with a significantly higher incidence of cardiovascular events by Kaplan-Meier analysis. By multivariate analysis, all tests of coronary vasoreactivity were significant, independent predictors of a poor prognosis, even after adjustment for traditional cardiovascular risk factors or the presence of atherosclerosis itself. Conclusions-Coronary endothelial vasodilator dysfunction predicts long-term atherosclerotic disease progression and cardiovascular event rates. Thus, the assessment of coronary endothelial vasoreactivity can provide pivotal information as both a diagnostic and prognostic tool in patients at risk for coronary heart disease.
引用
收藏
页码:1899 / 1906
页数:8
相关论文
共 50 条
  • [11] The long-term impact of the national service framework for coronary heart disease
    Cooper, K.
    Bishop, E.
    O'Flaherty, M.
    Turner, D.
    Raftery, J.
    JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, 2008, 62 : A29 - A29
  • [12] Long-term Outcome of Very Old Coronary Heart Disease Patients after Percutaneous Coronary Intervention
    Xiang, L.
    Luo, D.
    Yang, W.
    Wang, Y.
    Li, W. J.
    Zhang, W.
    Ren, Y. P.
    Su, X. M.
    JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 2018, 66 : S468 - S469
  • [13] Biomarkers for Non-Invasive Stratification of Coronary Artery Disease and Prognostic Impact on Long-Term Survival in Patients with Stable Coronary Heart Disease
    Netto, Jeffrey
    Teren, Andrej
    Burkhardt, Ralph
    Willenberg, Anja
    Beutner, Frank
    Henger, Sylvia
    Schuler, Gerhard
    Thiele, Holger
    Isermann, Berend
    Thiery, Joachim
    Scholz, Markus
    Kaiser, Thorsten
    NUTRIENTS, 2022, 14 (16)
  • [14] Lp(a) level is associated with long-term adverse outcomes in patients with coronary heart disease
    冯喆
    刘勇
    陈纪言
    周颖玲
    SouthChinaJournalofCardiology, 2017, 18 (01) : 12 - 20
  • [15] The impact of polyvascular disease on long-term outcome in percutaneous coronary intervention patients
    van der Meer, Manon G.
    Cramer, Maarten J.
    van der Graaf, Yolanda
    Appelman, Yolande
    Doevendans, Pieter A.
    Nathoe, Hendrik M.
    EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, 2014, 44 (03) : 231 - 239
  • [16] Long-term outcome of coronary abnormalities in Kawasaki disease
    Nishikawa, H
    Matsushima, M
    Oohashi, N
    Kojima, N
    Nagashima, M
    PEDIATRIC RESEARCH, 2003, 53 (01) : 186 - 186
  • [17] Long-term Outcome of Coronary Abnormalities in Kawasaki Disease
    Hiroshi Nishikawa
    Masaki Matsushima
    Naoki Oohashi
    Namiko Kojima
    Masami Nagashima
    Pediatric Research, 2003, 53 : 186 - 186
  • [18] Impact of hyperuricemia on long-term adverse cardiovascular outcome in patients presenting with acute coronary syndrome undergoing coronary stenting
    Tscharre, M.
    Rohla, M.
    Hauser, C.
    Farhan, S.
    Freynhofer, M. K.
    Huber, K.
    Weiss, T. W.
    WIENER KLINISCHE WOCHENSCHRIFT, 2017, 129 : S93 - S93
  • [19] Ventricular Dysfunction in Patients with Acute Coronary Syndrome Undergoing Coronary Surgical Revascularization: Prognostic Impact on Long-Term Outcomes
    Popovic, Batric
    Agrinier, Nelly
    Voilliot, Damien
    Elfarra, Mazen
    Villemot, Jean Pierre
    Maureira, Pablo
    PLOS ONE, 2016, 11 (12):
  • [20] LONG-TERM IMPACT OF SMOKING CESSATION ON THE INCIDENCE OF CORONARY HEART-DISEASE
    TOSTESON, ANA
    WEINSTEIN, MC
    WILLIAMS, LW
    GOLDMAN, L
    AMERICAN JOURNAL OF PUBLIC HEALTH, 1990, 80 (12) : 1481 - 1486