心疾患の基礎にあるPADの徴候（Abstract# SSM03-05）

重篤な無症候性の冠動脈疾患は末梢動脈疾患と合併する可能性がある
Severe asymptomatic coronary artery disease may accompany peripheral artery disease
2009年Radiological Society of North America学会（RSNA 2009）で発表された無作為化コントロール試験の結果、末梢動脈疾患（PAD）患者5人に1人は有意なしかし無症状の冠動脈疾患を有することが示された。オランダの4つの病院のPAD患者231人（62±7.2歳）を2つの群（標準治療[生活習慣改善および薬物治療]を受ける群108人、および標準治療に加え心臓の画像検査を受ける群115人）に割り付けた。コンピュータ断層撮影検査の結果53人（46%）が少なくとも1つの有意な冠動脈狭窄病変を有していた。このうち22人が左主幹動脈の狭窄またはそれに匹敵する病変を有しており治療が必要と考えられた。これらの患者のうち8人がバイパス手術を受け、3人が冠動脈造影およびステント留置を施行された。残りの患者は薬物で治療された。その後に76人の患者に施行された負荷MRIの結果、さらに2人の患者にCADの徴候が認められ、うち1人に冠動脈造影およびステント留置が行われた。画像検査を施行された115人中、計24人（21%）に無症候性のしかし治療を必要とする重症のCADが認められた。
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Results of a randomized, controlled clinical trial presented at the annual meeting of the Radiological Society of North America (RSNA) reveal that one in five patients with narrowing or blockage in arteries that supply blood to the legs and other parts of the body also have significant but silent coronary artery disease.

"Peripheral arterial disease (PAD) patients, including those experiencing no symptoms of heart disease, are known to be at high risk for cardiovascular events such as heart attack or stroke," said Rozemarijn Vliegenthart Proenca, M.D., Ph.D., radiology resident at the University Medical Center Groningen in the Netherlands.

"The purpose of our clinical trial was to investigate whether noninvasive imaging of the heart and subsequent treatment of PAD patients result in a decrease in cardiac events compared to standard care."

In the clinical trial, a total of 231 PAD patients from four participating hospitals in the Netherlands were divided into one of two groups: one in which 108 patients received standard care? consisting of lifestyle changes and medication?for their condition, and a second group in which 115 patients underwent cardiac imaging of the heart in addition to standard care. "With new, noninvasive cardiac imaging techniques, asymptomatic coronary atherosclerosis can be readily detected and treated," Dr. Vliegenthart Proenca said.

Among the 115 patients who received cardiac imaging, computed tomography (CT) revealed that 53, or 46 percent, had at least one significant narrowing of a coronary artery. Of those 53 patients, 22 had significant narrowing in the left main coronary artery or its equivalent, and were referred for treatment. Eight of those patients subsequently had bypass surgery, and three underwent coronary angiography with stent placement. The remaining patients were treated with medication.

Cardiac stress MRI was then performed on 76 patients. Results of the cardiac stress MRI exams identified two additional patients with signs of coronary artery disease, one of whom underwent angiography and stent placement.

In total, 24 (21 percent) of the 115 patients who underwent imaging had evidence of asymptomatic but severe coronary artery disease that required additional treatment.

"In PAD patients experiencing no cardiac symptoms, we found a strikingly high rate of severe coronary artery disease," Dr. Vliegenthart Proenca said. "The results of our trial stress that PAD patients without a history of cardiac symptoms should undergo extensive cardiovascular risk factor management."

Coauthors are Alexander de Vos, M.D., Ph.D., Matthijs Oudkerk, M.D., Ph.D., Mathias Prokop, M.D., Ph.D., Michiel Bots, M.D., Ph.D., Willem Mali, M.D., Ph.D., Annemarieke Rutten, M.D., Ph.D., Gonda de Jonge, M.D., Daniel Lubbers, M.D., Jan van den Dungen, M.D., Ph.D., Maarten Cramer, M.D., Ph.D., Pieter Doevendans, M.D., Ph.D., Benno Rensing, M.D., Ph.D., Hester van der Zaag-Loonen, M.D., Ph.D., and Felix Zijlstra, M.D., Ph.D.