Aus der II. Medizinischen Klinik der Universitatsmedizin der
Johannes Gutenberg-Universitat Mainz
Predictive Value of Flow-Mediated Dilation and Constriction in
the Diagnosis of Coronary Artery Disease.
Der pradiktive Wert der Fluss-mediierten Gefaftdilatation und
Konstriktion fur die Diagnose der Koronaren Herzerkrankung.
Dissertation
zur Erlangung des Doktorgrades der Medizin
der Universitatsmedizin der Johannes Gutenberg-Universitat Mainz
vorgelegt von
Selina Muxel
aus Grafelfing bei Munchen
Mainz, 2013
http://d-nb.info/1056820357
Table of contents:
Chronology
iii
List of tables:
vi
List of figures
viii
Abbreviations
ix
1. Introduction
1
2. Literature review
3
2.1. Atherosclerosis and Coronary Artery Disease
3
2.1.1. Definition and relevance of atherosclerosis and coronary artery disease in
the past and today
3
2.1.2. The pathogenesis of atherosclerosis
5
2.1.3. The cardiovascular risk factors
10
2.1.4. Clinical risk stratification systems and their limitations
13
2.1.5. The history and the current status of invasive coronary angiography
15
2.2. Endothelial function and vascular homeostasis
16
2.2.1. The endothelium and its importance for vascular function and homeostasis
16
2.2.2. The regulation of endothelial function by different stimuli
18
2.2.3. Endothelial dysfunction as marker of vascular failure
19
2.2.4. Assessment of endothelial function
20
3. Material and Methods
25
3.1. Goal of the study
25
3.1. Design of the study protocol and subjects
25
3.2. Assessment of endothelial function
26
3.3. Investigation of different blood parameters
32
3.4. Coronary angiography with Judkins technique and its interpretation
34
3.5. Determination of the SYNTAX score
34
3.6. Statistical methods
35
iv
4. Results
36
4.1. Characteristics of the study population
36
4.2. Association between parameters of endothelial function and association with
baseline diameter
40
4.3. Association between coronary risk factors and CAD
42
4.4. Association between risk factors and endothelial function parameters
43
4.5. Association of endothelial function parameters with CAD
45
4.6. The role of the parameters of endothelial function and coronary risk factors in
predicting CAD
48
4.7. Receiver operating characteristics analysis
51
4.8. Reclassification properties
55
5. Discussion
60
5.1. The relationship between blood parameters and endothelial function
62
5.2. The relationship between coronary risk factors and endothelial function
64
5.3. The limitation of risk scores in predicting CAD
67
5.4. The role of endothelial function in predicting CAD
69
5.5. The association between baseline diameter and endothelial responsiveness 71
5.6. FMC and FMD as complementary parameters of endothelial function
73
5.7. Limitations
74
5.8. Perspectives
76
6. Summary
78
Zusammenfassung:
80
7. References
A
8. Appendix
X
Acknowledgement:
DD
Curriculum Vitae
EE
v