Reis S E, Holubkov R, Conrad Smith A J, Kelsey S F, Sharaf B L, Reichek N, Rogers W J, Merz C N, Sopko G, Pepine C J
Cardiovascular Institute and Department of Epidemiology, University of Pittsburgh, PA, USA.
Am Heart J. 2001 May;141(5):735-41. doi: 10.1067/mhj.2001.114198.
Chest pain in the absence of obstructive coronary artery disease (CAD) is common in women; it is frequently associated with debilitating symptoms and repeated evaluations and may be caused by coronary microvascular dysfunction. However, the prevalence and determinants of microvascular dysfunction in these women are uncertain.
We measured coronary flow velocity reserve (coronary velocity response to intracoronary adenosine) to evaluate the coronary microvasculature and risk factors for atherosclerosis in 159 women (mean age, 52.9 years) with chest pain and no obstructive CAD. All women were referred for coronary angiography to evaluate their chest pain as part of the Women's Ischemia Syndrome Evaluation (WISE) study.
Seventy-four (47%) women had subnormal (<2.5) coronary flow velocity reserve suggestive of microvascular dysfunction (mean, 2.02 +/- 0.38); 85 (53%) had normal reserve (mean, 3.13 +/- 0.64). Demographic characteristics, blood pressure, ventricular function, lipid levels, and reproductive hormone levels were not significantly different between women with normal and those with abnormal microvascular function. Postmenopausal hormone use within 3 months was significantly less prevalent among those with microvascular dysfunction (40% vs 60%, P =.032). Age and number of years past menopause correlated with flow velocity reserve (r = -0.18, P =.02, and r = -0.30, P <.001, respectively). No significant associations were identified between flow velocity reserve and lipid and hormone levels, blood pressure, and left ventricular ejection fraction.
Coronary microvascular dysfunction is present in approximately one half of women with chest pain in the absence of obstructive CAD and cannot be predicted by risk factors for atherosclerosis and hormone levels. Therefore, the diagnosis of coronary microvascular dysfunction should be considered in women with chest pain not attributable to obstructive CAD.
无阻塞性冠状动脉疾病（CAD）的女性中胸痛很常见；它常伴有使人衰弱的症状和反复检查，可能由冠状动脉微血管功能障碍引起。然而，这些女性中微血管功能障碍的患病率和决定因素尚不确定。
我们测量了冠状动脉血流储备（冠状动脉对冠状动脉内腺苷的速度反应），以评估159名有胸痛且无阻塞性CAD的女性（平均年龄52.9岁）的冠状动脉微血管系统和动脉粥样硬化危险因素。作为女性缺血综合征评估（WISE）研究的一部分，所有女性均接受冠状动脉造影以评估其胸痛情况。
74名（47%）女性冠状动脉血流储备低于正常水平（<2.5），提示微血管功能障碍（平均为2.02±0.38）；85名（53%）女性血流储备正常（平均为3.13±0.64）。微血管功能正常和异常的女性在人口统计学特征、血压、心室功能、血脂水平和生殖激素水平方面无显著差异。微血管功能障碍的女性在3个月内使用绝经后激素的比例显著较低（40%对60%，P = 0.032）。年龄和绝经后年限与血流储备相关（r分别为-0.18，P = 0.02；r为-0. 30，P < 0.001）。未发现血流储备与血脂和激素水平、血压及左心室射血分数之间存在显著关联。
在无阻塞性CAD的胸痛女性中，约一半存在冠状动脉微血管功能障碍，且无法通过动脉粥样硬化危险因素和激素水平进行预测。因此，对于无阻塞性CAD所致胸痛的女性，应考虑诊断冠状动脉微血管功能障碍。
