L’ÉTUDE DE LA FONCTION ENDOTHÉLIALE PERMET DE PRÉDIRE L’EXISTENCE ET LA SÉVÉRITÉ DE LA MALADIE CORONAIRE.
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Résumé
Prérequis : La dysfonction de l’endothélium est de plus en plus incriminée dans le processus athéromateux. Sa place dans la pratique clinique est cependant encore mal définie
Objectif : Etudier prospectivement la valeur diagnostique de la fonction endothéliale par rapport à la coronarographie et analyser la relation entre la sévérité de la dysfonction endothéliale et la diffusion de la maladie coronaire.
Méthode : Ont été inclus par tirage au sort 50 patients (37 hommes et 13 femmes) candidats à une coronarographie d’âge moyen égal à 59.9+12.6 ans. L’étude de la fonction endothéliale a été effectuée avant la coronarographie par la mesure échographique de l’accroissement relatif du diamètre de l’artère humérale (FMD%) après une ischémie provoquée de l’avant bras. Le traitement de l’insuffisance coronaire n’a pas été arrêté avant le test.
Résultat : Une dysfonction endothéliale a été objectivée chez 36 patients et une coronaropathie significative chez 38. La dysfonction endothéliale a été corrélée à la coronaropathie avec une sensibilité de 89.5%, une spécificité de 83%, une valeur prédictive positive (VPP) de 94.4% et une valeur prédictive négative de 71.4%. La corrélation linéaire entre la FMD% et le statut coronaire a été hautement significative (rs=-0.44 ; p=0.001). Un FMD% de 8% a permis une excellente séparation des patients à coronaires normales et multitronculaires. Dans l’analyse multivariée la dysfonction endothéliale a été le seul facteur prédictif indépendant de
coronaropathie (p=0.02).
Conclusion : La dysfonction endothéliale a été fortement corrélée à la coronaropathie (VPP=94.4%) avec une relation directe entre la sévérité de la dysfonction endothéliale et l’étendu de l’atteinte coronaire. La place de ce test mérite d’être précisée en pratique clinique car non invasif, fiable et peu coûteux.
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Références
- Esper RJ, Nordaby RA, Vilarino JO, et al. Endothelial dysfunction: a comprehensive appraisal. Cardiovasc Diabetol 2006;5:4.
- Corretti MC, Anderson TJ, Benjamin EJ, et al. 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. J Am Coll Cardiol 2002;39:257-65.
- Munzel T, Sinning C, Post F, et al. Pathophysiology, diagnosis and prognostic implications of endothelial dysfunction. Ann Med 2008;40:180-96.
- Osto E, Coppolino G, Volpe M, et al. Restoring the dysfunctional endothelium. Curr Pharm Des 2007;13:1053-68.
- Zhang C. The role of inflammatory cytokines in endothelial dysfunction. Basic Res Cardiol 2008;103:398-406.
- Pyke KE, Tschakovsky ME. The relationship between shear stress and flow-mediated dilatation: implications for the assessment of endothelial function. J Physiol 2005;568:357-69.
- Kathiresan S, Gona P, Larson MG, et al. Cross-sectional relations of multiple biomarkers from distinct biological pathways to brachial artery endothelial function. Circulation 2006;113:938-45.
- Vallbracht-Israng KB, Kazak I, Schwimmbeck PL. Association of cytokines with endothelium dependent flow mediated vasodilation (FMD) of systemic arteries in patients with non-ischemic cardiomyopathy. Cardiovasc Ultrasound 2007;5:49.
- Kasprzak JD, Klosinska M, Drozdz J. Clinical aspects of assessment of endothelial function. Pharmacol Rep 2006;58:33-40.
- Jadhav UM, Sivaramakrishnan A, Kadam NN. Noninvasive assessment of endothelial dysfunction by brachial artery flowmediated dilatation in prediction of coronary artery disease in Indian subjects. Indian Heart J 2003;55:44-8.
- Papaioannou GI, Kasapis C, Seip RL, et al. Value of peripheral vascular endothelial function in the detection of relative myocardial ischemia in asymptomatic type 2 diabetic patients who underwent myocardial perfusion imaging. J Nucl Cardiol 2006;13:362-8.
- Karatzi K, Papamichael C, Karatzis E, et al. Acute smoking induces endothelial dysfunction in healthy smokers. Is this reversible by red wine's antioxidant constituents? J Am Coll Nutr 2007;26:10-5.
- Papamichael CM, Aznaouridis KA, Stamatelopoulos KS, et al. Endothelial dysfunction and type of cigarette smoked: the impact of 'light' versus regular cigarette smoking. Vasc Med 2004;9:103-5.
- Ambrose JA, Barua RS. The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol 2004;43:1731-7.
- Leone A, Balbarini A. Exposure to passive smoking: a test to predict endothelial dysfunction and atherosclerotic lesions. Angiology 2008;59:220-3.
- Bugiardini R. Endothelial function and the prediction of CVD in diabetes. Curr Diab Rep 2006;6:17-21.
- Wadham C, Parker A, Wang L, et al. High glucose attenuates protein S-nitrosylation in endothelial cells: role of oxidative stress. Diabetes 2007;56:2715-21.
- Melikian N, Chowienczyk P, MacCarthy PA, et al. Determinants of endothelial function in asymptomatic subjects with and without the metabolic syndrome. Atherosclerosis 2008;197:375-82.
- Donahue RP, Rejman K, Rafalson LB, et al. Sex differences in endothelial function markers before conversion to pre-diabetes: does the clock start ticking earlier among women? The Western New York Study. Diabetes Care 2007;30:354-9.
- Portaluppi F, Boari B, Manfredini R. Oxidative stress in essential hypertension. Curr Pharm Des 2004;10:1695-8.
- Buus NH, Jorgensen CG, Mulvany MJ, et al. Large and small artery endothelial function in patients with essential hypertension--effect of ACE inhibition and beta-blockade. Blood Press 2007;16:106-13.
- Zhang WZ, Venardos K, Finch S, et al. Detrimental effect of oxidized LDL on endothelial arginine metabolism and transportation. Int J Biochem Cell Biol 2008;40:920-8.
- Norata GD, Tonti L, Roma P, et al. Apoptosis and proliferation of endothelial cells in early atherosclerotic lesions: possible role of oxidised LDL. Nutr Metab Cardiovasc Dis 2002;12:297-305.
- Wilkinson I, Cockcroft JR. Cholesterol, lipids and arterial stiffness. Adv Cardiol 2007;44:261-77.
- Vlachopoulos C, Aznaouridis K, Dagre A, et al. Protective effect of atorvastatin on acute systemic inflammation-induced endothelial dysfunction in hypercholesterolaemic subjects. Eur Heart J 2007;28:2102-9.
- Yavuz BB, Yavuz B, Sener DD, et al. Advanced age is associated with endothelial dysfunction in healthy elderly subjects. Gerontology 2008;54:153-6.
- Mizia-Stec K, Gasior Z, Mizia M, et al. Flow-mediated dilation and gender in patients with coronary artery disease: arterial size influences gender differences in flow-mediated dilation. Echocardiography 2007;24:1051-7.
- Teragawa H, Ueda K, Matsuda K, et al. Relationship between endothelial function in the coronary and brachial arteries. Clin Cardiol 2005;28:460-6.
- Ercan E, Tengiz I, Duman C, et al. Investigation of flow-mediated dilation response in normal coronary angiographic patients. Angiology 2005;56:671-5.
- Arbel Y, Dvir D, Feinberg MS, et al. The association between right coronary artery morphology and endothelial function. Int J Cardiol 2007;115:19-23.
- Amir O, Jaffe R, Shiran A, et al. Brachial reactivity and extent of coronary artery disease in patients with first ST-elevation acute myocardial infarction. Am J Cardiol 2006;98:754-7.
- Matsushima Y, Takase B, Uehata A, et al. Comparative predictive and diagnostic value of flow-mediated vasodilation in the brachial artery and intima media thickness of the carotid artery for assessment of coronary artery disease severity. Int J Cardiol 2007;117:165-72.
- Fichtlscherer S, Breuer S, Zeiher AM. Prognostic value of systemic endothelial dysfunction in patients with acute coronary syndromes: further evidence for the existence of the "vulnerable" patient. Circulation 2004;110:1926-32.
- Akcakoyun M, Kargin R, Tanalp AC, et al. Predictive value of noninvasively determined endothelial dysfunction for long-term cardiovascular events and restenosis in patients undergoing coronary stent implantation: a prospective study. Coron Artery Dis 2008;19:337-43.
- Matsuo S, Nakae I, Matsumoto T, et al. Impact of endothelial dysfunction on left ventricular remodeling after successful primary coronary angioplasty for acute myocardial infarction--analysis by quantitative ECG-gated SPECT. Ann Nucl Med 2006;20:57-62.
- Rubba P. Effects of atorvastatin on the different phases of atherogenesis. Drugs 2007;67:17-27.
- Lovren F, Pan Y, Quan A, et al. Angiotensin Converting Enzyme-2 (ACE2) confers endothelial protection and attenuates atherosclerosis. Am J Physiol Heart Circ Physiol 2008 ;295 :H1377-84
- Benndorf RA, Appel D, Maas R, et al. Telmisartan improves endothelial function in patients with essential hypertension. J Cardiovasc Pharmacol 2007;50:367-71.
- Mason RP, Kubant R, Heeba G, et al. Synergistic effect of amlodipine and atorvastatin in reversing LDL-induced endothelial dysfunction. Pharm Res 2008;25:1798-806.
- Naya M, Tsukamoto T, Morita K, et al. Olmesartan, but not amlodipine, improves endothelium-dependent coronary dilation in hypertensive patients. J Am Coll Cardiol 2007;50:1144-9.
- Chamontin B. [The best of hypertension 2005]. Arch Mal Coeur Vaiss 2006;99 (Spec No 1):35-41.
- Agabiti Rosei E, Rizzoni D. Metabolic profile of nebivolol, a betaadrenoceptor antagonist with unique characteristics. Drugs 2007;67:1097-107.
- Tiefenbacher CP, Kreuzer J. Nitric oxide-mediated endothelial dysfunction--is there need to treat? Curr Vasc Pharmacol 2003;1:123- 33.
- Donald AE, Halcox JP, Charakida M, et al. Methodological approaches to optimize reproducibility and power in clinical studies of flow-mediated dilation. J Am Coll Cardiol 2008;51:1959-64.