AIM:The purpose of the current study was to determine if long term treatment with an endothelin-A (ETA) receptor antagonist attenuates the progression of coronary plaques in patients with coronary endothelial dysfunction. METHODS:Thirty-five patients with non-obstructive coronary disease and coronary endothelial dysfunction were randomized in a double blind manner to treatment with placebo or ETA receptor antagonist Atrasentan (10 mg) for six months. Endothelial function was assessed by the change in coronary blood flow and coronary artery diameter in response to intracoronary acetylcholine. Normalized mean total atheroma volume (TAVMEAN), percent atheroma volume (PAV) and changes of atheroma volume were assessed by intravascular ultrasound (IVUS) at baseline and 6-month follow-up. RESULTS:In segments with coronary endothelial dysfunction, there was a significant decrease in normalized TAVMEAN and PAV at six months from baseline in the Atrasentan group compared to the placebo group median (IQR) -2.00 mm(3) (-7.28, 2.53.) vs 9.11 mm(3) (1.23, 14.05), p=0.0024 and 0.955% (-3.43, 1.70) vs 3.85% (-0.39, 14.59) p=0.010. There was no change in normalized TAV or PAV in the segments with normal endothelial function. CONCLUSION:This study demonstrates that 6-month treatment with Atrasentan attenuates progression of coronary plaque in segments with endothelial dysfunction.

译文

目的:本研究的目的是确定长期使用内皮素-A(ETA)受体拮抗剂治疗是否能减轻冠状动脉内皮功能障碍患者的冠状动脉斑块进展。
方法:将35例非阻塞性冠心病和冠状动脉内皮功能障碍的患者以双盲方式随机分配接受安慰剂或ETA受体拮抗剂阿曲生坦(10 mg)治疗六个月。通过响应冠状动脉内乙酰胆碱引起的冠状动脉血流量和冠状动脉直径的变化来评估内皮功能。在基线和6个月的随访中,通过血管内超声(IVUS)评估标准化平均总动脉粥样硬化体积(TAVMEAN),动脉粥样硬化体积百分比(PAV)和动脉粥样硬化体积变化。
结果:与安慰剂组中位数(IQR)-2.00 mm(3)相比,在Atrasentan组中从基线开始六个月的冠状动脉内皮功能障碍的正常化TAVMEAN和PAV显着降低(-7.28,2.53。) vs 9.11 mm(3)(1.23,14.05),p = 0.0024和0.955%(-3.43,1.70)vs 3.85%(-0.39,14.59)p = 0.010。具有正常内皮功能的节段中的标准化TAV或PAV没有变化。
结论:这项研究表明,阿特拉森坦治疗6个月可减轻具有内皮功能障碍的部分中冠状动脉斑块的进展。

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