中心动脉压与冠状动脉病变程度及预后的关系
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摘要
目的探讨中心动脉压与冠心病患者冠状动脉病变程度及预后的关系。方法选择2011年11月至2012年10月烟台市莱阳中心医院心内科冠状动脉造影确诊为冠心病患者98例,年龄45~82岁,其中合并高血压组54例,根据病变支数分为单支病变组(48例)和多支病变组(50例),冠状动脉造影结束后,同步测量升主动脉根部(直接测量法)和肱动脉(袖带加压法)的血压,记录中心动脉及肱动脉压力参数,随访2年并比较两组患者主要心血管事件(MACE)的发生情况。结果多支病变组中心动脉收缩压(CASP)、中心动脉脉压(CAPP)、肱动脉收缩压(SBP)、肱动脉舒张压(DBP)水平高于单支病变组(均为P<0.05)。Kaplan-Meier生存分析显示:CAPP≥49 mmHg(中位数)时MACE发生风险明显增高(χ~2=11.216,P=0.001),冠状动脉多支病变患者MACE发生风险明显高于单支病变患者(χ~2=7.716,P=0.005)。在校正年龄、BMI、吸烟及血压水平等因素后,多变量Cox回归分析显示:CAPP(RR:1.095,95%CI:1.030~1.165,P=0.004)是MACE的危险因素。结论中心动脉压水平与冠心病患者冠状动脉病变程度关系密切,CAPP是MACE的危险因素。
Objective To investigate the relationship between central arterial pressure(CAP) and severity of coronary artery lesions,and predictive value of CAP.Methods The 98 coronary heart disease(CHD) patients proved by coronary angiography were enrolled in this study from November 2011 to October2012 in our hospital.The average age was(65.7 ± 9.8) years old.The 54 patients combined with hypertension.There were two groups according to the number of lesional vessels:single vessel group(n =48) and multi-vessels group(n =50).Ascending aortic pressure was measured by catheter during coronary angiography,and brachial blood pressure(BP) was measured by a standard sphygmomanometer.BP data was collected for all participants.MACE was recorded during two years follow up.Results CASP,CAPP,SBP and DBP were all higher in multi vessels group than those in the single vessel group(all P < 0.05).Kaplan-Meier survival curves showed that MACE was significantly higher when CAPP was ≥49 mmHg(χ~2=11.216,P =0.001).MACE was obviously higher in multi-vessels group than in single vessel group(χ~2 =7.716,P = 0.005).CAPP was the risk factor for MACE after adjustment by age,BMI,smoke and BP(RR:1.095,95%CI:1.030-1.165,P=0.004).Conclusions There is a close relationship between CAP and severity of coronary artery lesion.CAPP is a main risk factor for MACE in patients with CHD.
Objective To investigate the relationship between central arterial pressure(CAP) and severity of coronary artery lesions,and predictive value of CAP.Methods The 98 coronary heart disease(CHD) patients proved by coronary angiography were enrolled in this study from November 2011 to October2012 in our hospital.The average age was(65.7 ± 9.8) years old.The 54 patients combined with hypertension.There were two groups according to the number of lesional vessels:single vessel group(n =48) and multi-vessels group(n =50).Ascending aortic pressure was measured by catheter during coronary angiography,and brachial blood pressure(BP) was measured by a standard sphygmomanometer.BP data was collected for all participants.MACE was recorded during two years follow up.Results CASP,CAPP,SBP and DBP were all higher in multi vessels group than those in the single vessel group(all P < 0.05).Kaplan-Meier survival curves showed that MACE was significantly higher when CAPP was ≥49 mmHg(χ~2=11.216,P =0.001).MACE was obviously higher in multi-vessels group than in single vessel group(χ~2 =7.716,P = 0.005).CAPP was the risk factor for MACE after adjustment by age,BMI,smoke and BP(RR:1.095,95%CI:1.030-1.165,P=0.004).Conclusions There is a close relationship between CAP and severity of coronary artery lesion.CAPP is a main risk factor for MACE in patients with CHD.
引文
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[4]左君丽,严子君,张瑞岩,等.评价无创中心动脉压与有创中心动脉压测量值的一致性[J].中华高血压杂志,2009,17(4):343-346.DOI:10.16439/j.cnki.1673-7245.2009.04.014.Zuo JL,Yan ZJ,Zhang RY,et al.The agreement between noninvasive and invasive central blood pressure measurements[J].Chin J Hypertens,2009,17(4):343-346.DOI:10.16439/j.cnki.1673-7245.2009.04.014.
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[8]Chiadoni L,Bruno RM,Cartoni G,et al.Combination therapy with lercanidipine and enalapril reduced central blood pressure augmentation in hypertensive patients with metabolic syndrome[J].Vascul Pharmacol,2015,4(15):1016-1020.DOI:10.1016/j.vph.2015.06.004.
[9]Mancia R,Fagard K,Narkiewicz K,et al.2013 ESH/ESC guidelines for the management of arterial hypertension:the task force for the management of arterial hypertension of the European Society of Hypertension(ESH)and of the European Society of Cardiology(ESC)[J].J Hypertens,2013,31(7):1281-1357.DOI:10.1097/01.hjh.0000431740.32696.cc.
[10]Roman MJ,Devereux RB,Kizer JR,et al.High central pulse pressure is independently associated with adverse cardiovascular outcome:the strong heart study[J].J Am Coll Cardiol,2009,54(18):1730-1734.DOI:10.1016/j.jacc.2009.05.070.
[11]Vlachopoulos C,Aznaouridis K,O'Rourke MF,et al.Prediction of cardiovascular events and all-cause mortality with central haemodynamics:a systematic review and meta-analysis[J].Eur Herat J,2010,31(15):1865-1871.DOI:10.1093/eurheartj/ehq024.
[12]Williams B,Lacy PS,Yan P,et al.Development and validation of a novel method to derive central aortic systolic pressure from the radial pressure wave form using an N-point moving average method[J].J Am Coll Cardiol,2011,57(8):951-961.DOI:10.1016/j.jacc.2010.09.054.
[13]Pauca AL,O'Rourke MF,Kon ND,et al.Prospective evaluation of a method for estimating ascending aortic pressure from the radial artery pressure waveform[J].Hypertension,2001,38(4):932-937.DOI:10.1161/hy1001.096106.
[2]Roman MJ,Devereux RB,Kizer JR,et al.Central pressure more strongly relates to vascular disease and outcome than does brachial pressure:the Strong Heart Study[J].Hypertension,2007,50(1):197-203.DOI:10.1161/HYPERTENSIONAHA.107.089078.
[3]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743.DOI:10.16439/j.cnki.1673-7245.2011.08.009.Writing group of 2010 Chinese guidelines for the management of hypertension.2010 Chinese guidelines for the management of hypertension[J].Chin J Hypertens,2011,19(8):701-743.DOI:10.16439/j.cnki.1673-7245.2011.08.009.
[4]左君丽,严子君,张瑞岩,等.评价无创中心动脉压与有创中心动脉压测量值的一致性[J].中华高血压杂志,2009,17(4):343-346.DOI:10.16439/j.cnki.1673-7245.2009.04.014.Zuo JL,Yan ZJ,Zhang RY,et al.The agreement between noninvasive and invasive central blood pressure measurements[J].Chin J Hypertens,2009,17(4):343-346.DOI:10.16439/j.cnki.1673-7245.2009.04.014.
[5]Safar ME,Blacher J,Protogerou A,et al.Arterial stiffness and central hemodynamics in treated hypertensive subjects according to brachial blood pressure classification[J].J Hypertens,2008,26(1):130-137.DOI:10.1097/HJH.0b013e3282f16a9c.
[6]Weber T,Auer J,O'Rourke MF,et al.Arterial stiffness,wave reflections,and the risk of coronary artery disease[J].Circulation,2004,109(2):184-189.DOI:10.1161/01.CIR.0000105767.94169.E3.
[7]Chirinos JA,Zambrano JP,Chakko S,et al.Aortic pressure augmentation predicts adverse cardiovascular events in patients with established coronary artery disease[J].Hypertension,2005,45(5):980-985.DOI:10.1161/01.HYP.0000165025.16381.44.
[8]Chiadoni L,Bruno RM,Cartoni G,et al.Combination therapy with lercanidipine and enalapril reduced central blood pressure augmentation in hypertensive patients with metabolic syndrome[J].Vascul Pharmacol,2015,4(15):1016-1020.DOI:10.1016/j.vph.2015.06.004.
[9]Mancia R,Fagard K,Narkiewicz K,et al.2013 ESH/ESC guidelines for the management of arterial hypertension:the task force for the management of arterial hypertension of the European Society of Hypertension(ESH)and of the European Society of Cardiology(ESC)[J].J Hypertens,2013,31(7):1281-1357.DOI:10.1097/01.hjh.0000431740.32696.cc.
[10]Roman MJ,Devereux RB,Kizer JR,et al.High central pulse pressure is independently associated with adverse cardiovascular outcome:the strong heart study[J].J Am Coll Cardiol,2009,54(18):1730-1734.DOI:10.1016/j.jacc.2009.05.070.
[11]Vlachopoulos C,Aznaouridis K,O'Rourke MF,et al.Prediction of cardiovascular events and all-cause mortality with central haemodynamics:a systematic review and meta-analysis[J].Eur Herat J,2010,31(15):1865-1871.DOI:10.1093/eurheartj/ehq024.
[12]Williams B,Lacy PS,Yan P,et al.Development and validation of a novel method to derive central aortic systolic pressure from the radial pressure wave form using an N-point moving average method[J].J Am Coll Cardiol,2011,57(8):951-961.DOI:10.1016/j.jacc.2010.09.054.
[13]Pauca AL,O'Rourke MF,Kon ND,et al.Prospective evaluation of a method for estimating ascending aortic pressure from the radial artery pressure waveform[J].Hypertension,2001,38(4):932-937.DOI:10.1161/hy1001.096106.