Prognostische Bedeutung der endothelialen Dysfunktion

Zusammenfassung

Eine Reihe von Biomarkern und Risikoscores wurde entwickelt, um eine Risikostratifizierung bei gesunden und kranken Menschen, die ein kardiovaskuläres Risiko haben, durchzuführen. Obwohl sie auf Populationsebene wirken und in Guidelines implementiert wurden, wird trotzdem ein Teil der Population falsch klassifiziert. Wichtiger ist jedoch, dass die Aussagekraft auf dem Level einzelner Patienten niedrig ist und spezifische klinische Entscheidungen nicht allein dadurch getroffen werden können. Des Weiteren liefern diese Risikoscores keine Informationen über den Einfluss auf das Outcome der Patienten unter medikamentöser Therapie. Sie liefern ebenfalls keine Information, ob sich das individuelle Risiko über die Zeit verändert. Die Messung der endothelialen Funktion liefert Informationen über den gesamten Einfluss aller Risikofaktoren, bekannte und unbekannte, auf die gesamte Gefäßfunktion. Somit kann diese Messung theoretisch Informationen über den Einfluss der Risikofaktoren und den Einfluss einer Therapie eines einzelnen Patienten liefern. Während diese biologische Sichtweise solide erscheint, gibt es jedoch eine Reihe von Limitationen, die, technisch wie auch theoretisch, den Einsatz der Endothelfunktionsmessung in der täglichen Routine einschränken.

Abstract

A number of biomarkers or risk scores have been developed to allow risk stratification in patients and healthy subjects at risk for cardiovascular events. Although these scores work at a population level and are suited to design guidelines, yet a significant portion of the population is still misclassified. More importantly, the performance of these tools at the level of individual patients is relatively poor, and specific clinical decisions can hardly be made based on general risk scores. Further, risk scores do not provide information on the impact of medical treatments on patientsʼ outcome, and they do not provide information on whether the individual risk changes over time. The assessment of endothelial function is thought to provide information on the combined effect of all risk factors – known and unknown – on vascular function. Therefore, in theory, endothelial function assessment can theoretically provide information on the impact of these risk factors, and on the responsiveness to therapies, in individual patients. While this biological rationale appears to be solid, a number of limitations, both technical and theoretical, limit the impact of endothelial function assessment in daily clinical practice. These limitations are discussed in the present review.

Schlüsselwörter

endotheliale Funktion - Risikoscores - Gefäßfunktion

Key words

endothelial function - risk prediction - vascular function

• Literatur

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