踝臂指数和动态脉压与老年高血压合并冠心病的关系

目的研究踝臂指数(ABI)和动态脉压(PP)与老年高血压合并冠心病的关系,探讨ABI和动态PP在高血压、冠心病防治中的意义。方法对老年高血压患者进行ABI检测和动态血压检查,比较ABI降低组和ABI正常组的动态PP变化和冠心病发生率,以及24h平均脉压(24hAPP)<60mmHg组和≥60mmHg组的冠心病发生率,同时对单纯高血压组和高血压合并冠心病组的ABI和动态PP进行比较。结果①ABI减低组和ABI正常组的冠心病发生率分别是62.26%(33/53)和40.68%(24/59),两组比较差异有统计学意义(!2=4.38,P<0.05)。ABI减低组的24hAPP、白昼平均脉压(dPP)和夜间平均脉压(nPP)均较ABI正常组明显升高(P<0.05或P<0.01)。②24hAPP<60mmHg组合并冠心病39.58%(19/48),24hAPP≥60mmHg组合并冠心病60.94%(39/64),两组比较差异有统计学意义(!2=4.19,P<0.05)。③高血压合并冠心病组的24hAPP、dPP和nPP均显著高于单纯高血压组(P<0.01),而ABI则明显减低(P<0.01)。结论老年高血压患者检测AB...     

Raised ankle/brachial pressure index in insulin-treated diabetic patients

The ankle/brachial blood pressure index (A/B PI) is important in the vascular laboratory assessment of peripheral vascular disease. However it is falsely elevated in diabetes, hence underestimating the true severity of disease. We have therefore examined the influence of diabetes on the A/B PI in 2092 patients, 538 with diabetes, all referred for evaluation of peripheral vascular disease. The prevalence of a raised A/B PI (greater than or equal to 1.5) in insulin-treated patients (18.3%) was much higher (p less than 0.001) than that in both non-insulin-treated diabetic patients (4.5%) and patients with no diabetes (2.8%). Insulin-treated patients with a duration of diabetes of greater than 30 years had a higher prevalence of raised A/B PI than those with a duration of less than or equal to 9 years. No significant age effects were seen.     

2型糖尿病合并冠心病与踝臂指数相关性分析

目的：探讨2型糖尿病患者合并冠心病与踝臂指数（ABI）的相关性及糖尿病并发冠心病的危险因素。方法：选择2008年1月至2008年7月在新疆医科大学第五附属医院内分泌科住院的所有糖尿病患者,共269例,男158例,女111例。按有无冠心病分为冠心病组（54例）和无冠心病组（215例）。所有患者均记录生活方式,查体质指数（BMI）、心电图,测血压、血脂、空腹血糖（FBG）、餐后2h血糖（PBG）、糖化血红蛋白（HbAlC）、C反应蛋白（CRP）。并于入院3d内行ABI测定,同时进行Logistic冠心病多因素分析。结果：（1）合并冠心病组ABI的敏感性及特异性分别为77．8％、93．5％;（2）多因素分析表明ABI降低（OR=0．421,P=0．025）、BMI≥25（OR=1．148,P=0．007）、收缩压（OR=1．035,P=0．000）、总胆固醇水平升高和颈动脉斑块是冠心病的危险因素。结论：测定ABI能提高冠心病的诊断率。     

老年冠心病患者踝臂指数与冠状动脉病变SYNTAX积分相关性研究

目的 探讨踝臂指数与冠状动脉病变严重程度的关系,并评价其预测价值。方法 纳入2012年1月至2014年12月在南京医科大学第一附属医院心血管科及老年心血管科行冠状动脉造影,同时接受踝臂指数（ABI）和趾臂指数（TBI）检查的192例老年患者,根据冠状动脉造影结果及SYNTAX积分分为非冠心病组、冠心病低危组、中危组及高危组。分析非冠心病组与冠心病组、冠心病不同亚组间ABI、TBI水平的差异,利用Pearson相关性分析踝臂指数与SYNTAX积分的相关性,并利用ROC曲线分析ABI对预测冠心病的价值。结果 与非冠心病组比较,冠心病组ABI、TBI显著降低（ABI：1.032±0.189 vs 0.954±0.181;TBI：0.775±0.143 vs 0.740±0.176）,差异有统计学意义（P＜0.05）;冠心病组中低危组、中危组及高危组组间ABI、TBI呈降低趋势（ABI：1.004±0.170 vs 0.958±0.184 vs 0.875±0.167;TBI：0.768±0.108 vs 0.753±0.124 vs 0.679±0.179）,组间ABI、TBI比较,差异具有统计学意义（P＜0.05）。高危组ABI、TBI水平明显低于非冠心病组、低危组及中危组,差异具有统计学意义（P＜0.05）;中危组与非冠心病组ABI水平比较,差异有统计学意义（P＜0.05）。Person相关分析显示,ABI与SYNTAX积分呈轻度负相关（rho=-0.443,P＜0.001）。结论 ABI值能较好反映冠脉病变严重程度,ABI数值越低,冠状动脉病变SYNTAX积分越高。     

Carotid pressure is a better predictor of coronary artery disease severity than brachial pressure

The mechanisms relating pulse pressure to cardiovascular outcome may include surrogacy for coronary disease severity. Although pulse pressure is typically measured at the brachial artery, central pulse pressure and its principal determinant, large-artery stiffness, may relate more closely to disease severity. This study aimed to determine the relationships between large-artery stiffness and carotid and brachial blood pressures and coronary artery disease severity. One hundred fourteen male patients with coronary artery disease (age 60+/-8 years, mean+/-SD) and 57 age-matched healthy male controls (age 59+/-9 years) were recruited. Patients were classified into 2 groups based on the magnitude of their maximum coronary stenosis: moderate (50% to 89%) and severe (>/=90%). Large-artery stiffness was assessed as systemic arterial compliance and carotid-femoral pulse wave velocity. Mean pressure was not different between the 3 groups. Systemic compliance and carotid pulse pressure were significantly different between all 3 groups, with compliance lowest and pressure highest in the severe group (P<0.05). Pulse wave velocity was higher in patients with severe stenosis than in those with moderate stenosis (P<0.01) and those in the control group (P<0.001). Brachial pulse pressure was higher in patients than in controls (P<0.05), but there was no difference between the 2 disease groups. In separate multivariate analyses, carotid pressures and systemic arterial compliance were determinants of coronary artery disease severity, independent of age, smoking status, body mass index, mean arterial pressure, heart rate, cholesterol levels (total, LDL, and HDL), triglycerides, and beta-antagonist and lipid-lowering therapy (P<0.001), whereas brachial pressures and pulse wave velocity were not. In conclusion, central blood pressures and systemic arterial compliance are more sensitive markers of coronary artery disease severity than brachial pressures.     

Ankle brachial pressure index and carotid intima-media thickness as atherosclerosis markers in Japanese diabetics

The aim of this study was to assess the clinical significance of ankle brachial pressure index (ABI) and carotid intima-media thickness (IMT) in Japanese patients with type 2 diabetes. ABI and ultrasonographic carotid IMT measurements were made in 1311 patients and the relationships between ABI, IMT, and cardiovascular diseases were examined. Patients were assigned to one of three groups depending on their ABI index: (i) ABI > or = 1.0; (ii) ABI from > or = 0.9 to < 1.0; and (iii) ABI < 0.9. The odds ratios (ORs) for groups (ii) and (iii) compared with (i) for the prevalence of coronary heart disease (CHD), cerebrovascular disorder (CVD), and carotid atherosclerosis (mean carotid IMT > or = 1.1mm) demonstrated that these conditions were inversely related to ABI. As the combined ABI/carotid IMT score increased, each OR for the prevalence of CHD and CVD increased significantly. This suggests that a lower ABI is associated with generalized atherosclerosis. Measurements of the ABI and carotid IMT might provide a good prognostic indicator, and both should be assessed during screening for atherosclerosis in Japanese patients with type 2 diabetes.     

Role of ankle-brachial pressure index as a predictor of coronary artery disease severity in patients with diabetes mellitus

BACKGROUND:

Previous studies have reported a close correlation between low ankle-brachial pressure index (ABPI) and various cardiovascular risk factors. However, despite the well-established potential hazards of consequent coronary artery disease (CAD), no data exist on the relationship between ABPI and the severity of CAD, particularly in patients with diabetes mellitus (DM).

METHODS:

A total of 840 patients ranging from 35 to 87 years of age (mean [± SD] 63.9±10.2 years) with suspected CAD in a clinical practice were enrolled. All patients underwent ABPI measurements and coronary angiography. Patients were divided into four groups according to the results of ABPI measurements and the presence or absence of DM: group A had an ABPI value of at least 0.9 but no DM (A⁻/D⁻); group B had an ABPI value of at least 0.9 and DM (A⁻/D⁺); group C had an ABPI of less than 0.9 but no DM (A⁺/D⁻); and group D had an ABPI value of less than 0.9 and DM (A⁺/D⁺).

RESULTS:

Age was significantly higher in the A⁺ (groups C and D) than the A⁻ patients (groups A and B). Moreover, men predominated in all four groups. Comparisons of sex distribution among the four groups revealed that group D had the highest percentage of women, while group A had the lowest. Total cholesterol level did not differ among the four groups, although group D tended to have the highest result. Patients in group D had the highest percentages of hypertension, hypercholesterol, hypertriglyceride, low high-density lipoprotein cholesterol and high low-density lipoprotein cholesterol among the four groups. Group D exhibited the highest triglyceride and uric acid levels, the lowest high-density lipoprotein cholesterol level, and the highest metabolic syndrome criteria number and percentage of metabolic syndrome. Furthermore, group D had the highest mean lesion numbers, mean numbers of target vessel involvement, stenoses with type C classification and complex morphology lesions (chronic total occlusion, diffuse or calcified lesions) among the four groups. There were still significant differences in lesion numbers (P<0.001) and numbers of target vessel involvement (P<0.001) for ABPI predicting CAD severity after controlling for the effects of DM and age. The sensitivity, specificity, positive predictive value and negative predictive value of using an ABPI of less than 0.9 to predict CAD differed significantly between patients with and without DM.

CONCLUSIONS:

ABPI is a useful noninvasive tool for predicting CAD severity, even in patients with DM.     

老年冠心病患者踝/臂血压指数的观察

目的观察冠心病患者的影臂血压指数（ABI）。方法明确诊断冠心病患者77例（病例组）,对照组77例。按美国心脏病学会（AHA）推荐的测算方法,用选定的踝部收缩压除以选定的肱部收缩压计算ABI。ABI0．9～1．4为正常,0．6—0．9预示轻度异常,〈0．6预示明显异常。结果病例组和对照组ABI轻度异常率分别为63．64％和20．78％,明显异常率分别为36．36％和5．19％,2组比较,差异均有统计学意义（P〈0．01）。结论ABI可作为老年冠心病新的预测指标之一。     

Ankle brachial pressure index in systemic sclerosis: influence of disease subtype and anticentromere antibody

OBJECTIVE: To test the hypothesis that patients with limited cutaneous systemic sclerosis (SSc) have a higher incidence of lower limb large vessel disease than patients with diffuse cutaneous disease, and that anticentromere antibody is a risk factor for lower limb large vessel disease. METHODS: Clinical and laboratory data from 119 patients with SSc (91 patients with limited cutaneous disease, 28 patients with diffuse cutaneous disease) who had bilateral ankle brachial pressure indices (ABPI) measured between March 1997 and January 2000 were reviewed retrospectively. RESULTS: There was no evidence of reduced ABPI in limited cutaneous disease (P=0.65), average reduction 0.01 [95% confidence interval (CI) -0.04 to +0.07]. There was some suggestion of reduced ABPI in anticentromere-positive patients (P=0.12), average reduction 0.04 (95% CI -0.01 to +0.09). CONCLUSIONS: The severity of large vessel macrovascular disease, as assessed by ABPI, is not dependent on disease subtype. Anticentromere antibody may be weakly associated with a reduction in ABPI.     

The ankle—brachial index as a predictor of survival in patients with peripheral vascular disease

Objective: To determine whether the ankle—brachial index (ABI) predicts survival rates among patients with peripheral vascular disease. Design: A retrospective survival analysis of patients with abnormal ABIs who visited the authors’ blood-flow laboratory during 1987. The National Death Index was used to ascertain survival status for all patients up to January 1, 1992. Kaplan-Meier and Cox proportional hazards analyses were used to determine the relationship between increasing lower-extremity ischemia, measured by ABI, and survival time. Clinical characteristics controlled for included age, smoking history, gender, and comorbidities, as well as the presence of lower-extremity rest pain, ulcer, or gangrene. Setting: A university hospital blood-flow laboratory. Patients/participants: Four hundred twenty-two patients who had no prior history of lower-extremity vascular procedures and who had ABIs < 0.92 in 1987. Results: Cumulative survival probabilities at 52 months’ (4.3 years’) follow-up were 69% for patients who had ABIs =0.5–0.91, 62% for patients who had ABIs =0.31–0.49, and 47% for patients who had ABIs ≤0.3. In multivariate Cox proportional hazard analysis, the relative hazard of death was 1.8 (95% confidence interval =1.2–2.9, p<0.01) for the patients who had ABIs ≤0.3 compared with the patients who had ABIs 0.5–0.91. Other independent predictors of poorer survival included age >65 years (p<0.001); a diagnosis of cancer, renal failure, or chronic lung disease (p<0.001); and congestive heart failure (p<0.04). Conclusion: The ABI is a powerful tool for predicting survival in patients with peripheral vascular disease. Patients with ABIs ≤ 0.3 have significantly poorer survival than do patients with ABIs 0.31–0.91. Further study is needed to determine whether aggressive coronary risk-factor modification, a work-up for undiagnosed coronary or cerebrovascular atherosclerotic disease, or aggressive therapy for known atherosclerosis can improve survival of patients with ABIs ≤ 0.3. Presented at the annual meeting of the Society of General Internal Medicine, April 27–29, 1994, Washington, DC. Supported in part by grant number 1R01HS07184-01A2 from the Agency for Health Care Policy and Research to Northwestern University Medical School.     

Ankle/brachial blood pressure in men >70 years of age and the risk of coronary heart disease

Low ankle/brachial blood pressure index (ABI) is a marker of generalized atherosclerosis in the elderly, although its association with coronary heart disease (CHD) has not been well established. The purpose of this report is to examine the relation between ABI and the risk of CHD in a sample of elderly men. Findings are based on the ABI that was measured in 2,863 Japanese-American men aged 71 to 93 years at an examination that occurred from 1991 to 1993 in the Honolulu Heart Program. All men were free of total CHD at that time and followed for nonfatal myocardial infarction and death from CHD over a 3- to 6-year period. During follow-up, 186 had a coronary event. Age-adjusted incidence declined significantly from 15.3% in men with an ABI <0.8 to 5.4% in men with an ABI >/=1.0 (p <0.001). The effect of ABI on disease was similar across a variety of risk factor strata, although it seemed strongest in the presence of hypertension and in past and current cigarette smokers. Adjustment for other risk factors failed to diminish the relation between ABI and CHD. We conclude that a low ABI increases the risk of CHD in elderly men. If findings can be extended to other elderly population segments, simple measurement of ABI in an outpatient setting could be an important tool for assessing the risk of CHD in the elderly.     

脉压指数联合动脉硬化指数对冠心病患者冠状动脉病变严重程度的预测价值

[目的]探讨脉压指数(PPI)联合动脉硬化指数(AI)对冠心病患者冠状动脉病变严重程度的预测价值。[方法]选取2019年1月—10月在佛山市中医院经冠状动脉造影(CAG)检查诊断为冠心病的150例患者,分为单支组(36例)、双支组(49例)、三支组(65例);同期行CAG后排除冠心病的患者50例纳入对照组。冠心病分型：稳定型心绞痛(SAP)患者37例、不稳定型心绞痛(UAP)患者42例、急性非ST段抬高型心肌梗死(NSTEMI)患者35例、急性ST段抬高型心肌梗死(STEMI)患者36例。比较各组PPI、AI水平差异,并分析冠心病患者冠状动脉病变严重程度的影响因素。Gensini评分与PPI、AI水平的相关性采用Pearson分析。PPI、AI预测冠状动脉病变严重程度的效能采用ROC曲线分析。[结果]单支组、双支组及三支组PPI、AI水平依次增加(P<0.05)。SAP组、UAP组、NSTEMI组及STEMI组PPI、AI水平相比差异无统计学意义(P>0.05)。PPI、AI均与Gensini评分存在正相关(r=0.561、r=0.629,均P=0.000)。多因素Logi...     

C-reactive protein as a predictor for cardiac events in Chinese elderly patients with coronary heart disease

Background and objective To assess the predictive value of C-reactive protein(CRP) for major adverse cardiac events and the association between CRP level and the coronary lesion morphology and extent in patients with coronary heart disease (CHD). Methods CRP was measured on admission in 177 consecutive elderly (age>60 years) patients with CHD who underwent coronary angiography. Patients were divided into high CRP group (CRP≥3mg/L) and normal CRP group (CRP <3mg/L). The association between CRP levels and the coronary lesion features, including severity of stenosis (mild, moderate, severe), extent of lesion (diffused or non-diffused), eccentricity of the plaque (eccentric or non-eccentric) were analyzed. Patients were followed up for a mean of 8 months for the occurrences of major adverse cardiac events (MACE). Results Compared with patients in normal CRP group, patients in high CRP group were more frequently to have unstable angina, multi-vessel, diffuse, eccentric lesions, positive remodeling, and non-smooth plaques (P<0.01). Kaplan-Meier analysis showed patients in high CRP group had a significantly lower MACE-free survival rate than patients in normal CRP group (Log-rank =12.0, P<0.01); Cox regression analysis indicated CRP level as an independent predictor for the occurrence of MACE (OR=3.16, P<0.05) Conclusions High CRP level is associated with more extend, severe and eccentric coronary lesions and is an independent predictor for MACE in elderly patients with CHD.     

Importance of arterial pulse pressure as a predictor of coronary heart disease risk in PROCAM.

AIMS: To investigate pulse pressure (PP) as an independent predictor of coronary heart disease (CHD) risk. METHODS AND RESULTS: On the basis of a 10-year follow-up of 5389 men aged 35-65 at recruitment into PROCAM, we used a proportional hazards model to calculate the effect of systolic blood pressure (SBP), diastolic blood pressure (DBP), and PP on CHD risk after correcting for age, high-density lipoprotein cholesterol, LDL cholesterol, triglycerides, smoking, diabetes, and family history of premature CHD. Increases of 10 mmHg in DBP, SBP, and PP were associated with an increased CHD hazard ratio (HR) of approximately 10%. When the group was divided into the age groups <50, 50-59, and >59 years, this relationship was seen in the age group 50-59 years for DBP, SBP, and PP and in men aged > or =60 for PP only (25% increase in HR). Overall, CHD risk in men with PP > or =70 mmHg was more three times that of men with PP <50 mmHg. This increased risk was not apparent at age <50 years, was greatest at age >60 years, and was also present in men who were normotensive at recruitment (SBP < or =160 mmHg, DBP < or =95 mmHg). CONCLUSION: In older European men, increased PP is an important independent determinant of coronary risk, even among those initially considered normotensive.     

老年冠心病患者代谢指标与肱动脉舒张功能关系探讨

目的探讨老年冠心病患者代谢指标与肱动脉舒张功能间的相关性. 方法检测老年冠心病患者、老年健康者、非老年健康者的代谢指标并采用高分辨彩色超声技术检测肱动脉舒张功能反应性充血后血管舒张(FMD)、含服硝酸甘油后的血管舒张(NID)并进行分析. 结果 (1)老年冠心病组的甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、血尿酸(SUA)的水平显著高于老年和非老年健康组(均为P＜0.05),高密度脂蛋白胆固醇(HDL-C)水平显著低于老年和非老年健康组(均为P＜0.05),上述指标在两健康组间无差异;(2)老年冠心病组的FMD(4.44±1.17)%显著低于老年健康组和非老年健康组[分别为(6.90±1.47)%和(10.51±1.78)%,P＜0.01],非老年健康组的FMD显著高于老年健康组(P＜0.01);(3)年龄、TG、SUA、与FMD呈负相关(分别r＝-0.70,-0.29和-0.46,均P＜0.05),HDL-C与FMD呈正相关(r＝0.28,P＜0.05);(4)体质量指数(BMI)、LDL-C、SUA与TG呈正相关(r＝0.27,0.27和0.34,均P＜0.05). 结论老年冠心病患者存在血脂、SUA等代谢紊乱和血管内皮功能障碍,其中依赖性血管舒张功能障碍随增龄而加重,并与TG、HDL-C、SUA及老年冠心病间有显著相关性,SUA水平可能是内皮功能受损的标志或间接危险因素之一.     

Ankle-brachial pressure index measured using an automated oscillometric method as a predictor of the severity of coronary atherosclerosis in patients with coronary artery disease

Ankle-brachial pressure index (ABI) measured using a conventional Doppler method is an independent predictor of the number of coronary vessels affected in coronary artery disease (CAD). Recently, a new clinical device has been developed to measure ABI using an oscillometric method. It is unclear whether ABI measured using this device is a significant predictor of the severity of coronary atherosclerosis. We retrospectively included 87 patients from our outpatient clinic who had ever undergone coronary angiography. ABI was determined in all subjects using the new ABI-form device. The lower value of ABI in either limb was used for analysis. We divided our subjects into two groups, with either ABI less than 0.9 or at least 0.9, and compared basal characteristics between groups. We analyzed the relationship between ABI and the severity of CAD. In addition, we calculated the sensitivity, specificity, and positive and negative predictive values of ABI less than 0.9 in predicting multivessel (two-vessel + three-vessel) involvement in our patients. There were 15 patients with ABI less than 0.9 and 72 with ABI at least 0.9. Patients with ABI less than 0.9 were older and had higher plasma levels of uric acid. The prevalence of diabetes mellitus, hypertension, smoking, and diuretic use was significantly higher in patients with ABI less than 0.9. In addition, the group with ABI less than 0.9 had a lower prevalence of one-vessel CAD and higher prevalence of three-vessel or multivessel CAD. The sensitivity, specificity, and positive and negative predictive values of ABI less than 0.9 in predicting multivessel CAD were 22%, 96%, 93%, and 34%, respectively. In conclusion, ABI measured using the automated oscillometric method can be used to predict the severity of coronary atherosclerosis in patients with CAD.     

高血压患者动态脉压和脉压指数与 并发冠心病的关系

目的 探讨高血压患者24 h动态脉压（24hPP）、24 h动态脉压指数（24hPPI）与并发冠心病的关系。方法 选取2019年1~6月期间在安康市中医医院接受治疗的高血压患者150例,根据是否合并冠心病将其分为高血压组（96例）,高血压合并冠心病组（54例）。比较两组患者的一般资料及24hPP、24hPPI,分析高血压患者合并冠心病的危险因素,分析高血压合并冠心病患者24hPP、24hPPI与Gensini积分的相关性,分析24hPP、24hPPI对高血压合并冠心病的预测价值。结果 高血压合并冠心病组患者的年龄[(62.57±7.42)岁比（58.63±8.92）岁]、吸烟史占比（37.04%比19.79%）、低密度脂蛋白胆固醇（LDL-C）[（2.98±0.64）mmol/L比（2.75±0.58）mmol/L]、24hPP[（50.52±9.37）mmHg比（47.26±8.69）mmHg]、24hPPI[（0.42±0.07）比（0.37±0.08）]均高于高血压组,高密度脂蛋白胆固醇（HDL-C）[（1.50±0.48）mmol/L比（1.68±0.52）mmol/L]低于高血压组,差异均有统计学意义（P<0.05）。补充数据;Logistic回归分析结果显示,年龄越大、LDL-C升高、24hPP升高、24hPPI升高均是高血压患者合并冠心病的危险因素,而不吸烟则是高血压患者合并冠心病的保护因素（P<0.05）;Pearson分析显示,24hPP、24hPPI与Gensini积分均呈正相关（P<0.05）;24hPP、24hPPI对高血压合并冠心病均有一定的预测价值,24hPP的曲线下面积为0.669（95%CI 0.577~0.762）,截断值取49.44 mm Hg时,敏感度为66.70%,特异度为63.50%,约登指数为0.302,24hPPI的曲线下面积为0.730（95%CI 0.646~0.813）,截断值取0.39时,敏感度为70.40%,特异度为72.90%,约登指数为0.433。结论 24hPP、24hPPI升高均是高血压患者合并冠心病的危险因素,且与Gensini积分均呈正相关,二者对高血压合并冠心病均有一定的预测、筛查价值,但24hPPI的预测、筛查价值更高。