Дисфункция эндотелия у больных с острым коронарным синдромом


Full text:  

 

Abstract

In this study we compaired the endothelium function in patients with different forms of acute coronary syndromes (ACS), using the brachial artery flow-mediated dilation (FMD) test. One hundred twelve patients with ACS were included in the study. The patients were divided into two groups: group 1 (n=52), consisting of patients with ST elevation acute myocardial infarction (STEMI) and group 2 (n=60), consisting of patients with ACS without ST elevation. There were no significant differences of the FMD levels between these two groups. Then patients with ACS without ST elevation were divided in two subgroups: 2a (n=38) patients without ST elevation myocardial infarction (non STEMI), 2b (n=22) patients with unstable angina. There were no significant differences between the brachial artery FMD test in these subgroups. STEMI patients were divided into two subgroups too, on the basis of the results of coronary angiography: subgroup 1a (n=33), consisting of patients with remaining total occlusion of the infarct-related artery (IRA), and subgroup1b (n=19), consisting of patients with spontaneous thrombolysis. In subgroup 1b during the first 3 days of STEMI, brachial artery FMD results were significantly higher than those in subgroup 1a (13,07±7,78 vs 6,23±4,77; р<0,0001) and that of patients with unstable ungina. In conclusion: patients with spontaneous thrombolysis have higher results of FMD test as compared with other groups of patients with ACS.

References

1. Уразовская, И. Л. Влияние состояния эндотелия на возможность спонтанного тромболизиса у больных с острым инфарктом миокарда с подъемом сегмента ST / И. Л. Уразовская, Д. В. Скрыпник, Е. Ю. Васильева, А. В. Шпектор // Креативная кардиол. - 2008. - № 1. - С. 36-38.
2. Anderson, E. Flow-mediated and reflex changes in large peripheral artery tone in humans / E. Anderson, A. Mark // Circulation. - 1989. - Vol. 79. - P. 93-100.
3. Celermajer, D. Non-invasive detection of endothelial dysfunction in children and adult at risk of atherosclerosis / D. Celermajer, E. Sorensen, M. Gooch et al. // Lancet. - 1992. - Vol. 340. - P. 1111-1115.
4. Corretti, M. C. Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery. A report of the International Brachial Artery Reactivity Task Force / M. C. Corretti, D. Celermajer et al. // JACC. - 2002. - Vol. 39. - P. 108.
5. Deanfield, О. Endothelial function and dysfunction: testing and clinical relevance / О. Deanfield, P. Halcox, T. Rabelink // Circulation. - 2007. - Vol. 115. - P. 1285-1295.
6. Fichtlscherer, S. Prognostic value of systemic endothelial dysfunction in patients with acute coronary syndromes / S. Fichtlscherer, S. Breuer, A. M. Zeiher // Circulation. - 2004. - Vol. 110. - P. 1926-1932.
7. Karatzis, E. N. The long-term prognostic role of flow-mediated dilation of the brachial artery after acute coronary syndromes without ST elevation / E. N. Karatzis, I. Ikonomidis, G. D. Vamvakou // Am. J. Cardiol. - 2006. - Vol. 98. - P. 1424-1428
8. Laurent, S. Flow-dependent vasodilation of brachial artery in essential hypertension / S. Laurent, P. Lacolley, P. Brunel et al. // Am. J. Physiol. - 1990. - Vol. 258. - P. H1004-1011.
9. Lusher, T. Biology of the endothelium / T. Lusher, M. Barton // Clin. Cardiol. - 1997. - Vol. 20. - P. 3-10.
10. Sorensen, K. E. Non-invasive measurement of human endothelium dependent arterial responses: accuracy and reproducibility / K. E. Sorensen, D. S. Celermajer, D. J. Spiegelhalter et al. // Br. Heart J. - 1995. - Vol. 74. - P. 247-253.
11. Triggle, C. Endothelium derived hyperpolarizing factor( s) Species and tissue heterogeneity / C. Triggle, H. Dong, G. Waldron et al. // Lin. Exp. Pharmacol. Physiol. - 1999. - Vol. 26. - P. 176-179.
12. Urazovskaya, I. Patency of the infarct-related artery correlates with brachial artery flow-mediated dilation / I. Urazovskaya, E. Vasilieva, D. Skrypnik, A. Shpektor // Progress in Acute Coronary Syndromes. - Rome. - Italy, 2007.

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery