Marroquin Oscar C, Holubkov Richard, Edmundowicz Daniel, Rickens Cheryl, Pohost Gerald, Buchthal Steven, Pepine Carl J, Sopko George, Sembrat Robert C, Meltzer Carolyn Cidis, Reis Steven E
Cardiovascular Institute, University of Pittsburgh, Pittsburgh, Pa, USA.
Am Heart J. 2003 Apr;145(4):628-35. doi: 10.1067/mhj.2003.95.
Women with chest pain in the absence of obstructive coronary artery disease (CAD) frequently have coronary microvascular dysfunction and inducible myocardial ischemia. Microvascular dysfunction is commonly diagnosed by demonstrating abnormal flow reserve in a single coronary artery during angiography. Therefore, diagnostic accuracy is dependent on homogeneity of microvascular dysfunction in the myocardium.
In the Women's Ischemia Syndrome Evaluation (WISE), 34 women with chest pain and no significant CAD and 9 female control subjects underwent 13N-NH3 positron emission tomography to measure adenosine-induced changes in myocardial perfusion (ie, coronary flow reserve [CFR]). Flow reserve was correlated among the left anterior descending (LAD), circumflex (LCx), and right (RCA) coronary artery distributions.
The mean CFR in the LAD, LCx, and RCA was 2.85 +/- 1.35, 2.58 +/- 0.94, and 3.24 +/- 1.42, respectively. Concordance in the classification of microvascular function as normal (CFR > or =2.5) versus abnormal was present in the LAD and RCA, LAD and LCx, and RCA and LCx distributions in only 71.8%, 66.7%, and 61.6% of patients, respectively. There was a modest degree of correlation of CFR between the LAD and RCA (r = 0.79, P <.001), LAD and LCx (r = 0.61, P <.001), and LCx and RCA (r = 0.57, P <.001). Comparison of CFR in the 3 coronary arteries simultaneously in all patients demonstrated that the LCx had values that were significantly lower than the RCA and LAD distributions.
Substantial discordance of classification of microvascular function among coronary artery distributions in women with chest pain and no CAD suggests that microvascular dysfunction is distributed heterogeneously in the myocardium. Assessment of CFR in a single coronary artery during cardiac catheterization may not provide an accurate assessment of the coronary microcirculation in women with chest pain not attributable to CAD.
无阻塞性冠状动脉疾病（CAD）的胸痛女性常伴有冠状动脉微血管功能障碍和诱发性心肌缺血。微血管功能障碍通常通过血管造影时显示单支冠状动脉血流储备异常来诊断。因此，诊断准确性取决于心肌微血管功能障碍的同质性。
在女性缺血综合征评估（WISE）中，34例有胸痛且无显著CAD的女性和9例女性对照受试者接受了13N-NH3正电子发射断层扫描，以测量腺苷诱导的心肌灌注变化（即冠状动脉血流储备[CFR]）。左前降支（LAD）、回旋支（LCx）和右冠状动脉（RCA）分布区域的血流储备相互关联。
LAD、LCx和RCA的平均CFR分别为2.85±1.35、2.58±0.94和3.24±1.42。仅在71.8%、66.7%和61.6%的患者中，LAD与RCA、LAD与LCx以及RCA与LCx分布区域的微血管功能分类（正常[CFR≥2.5]与异常）具有一致性。LAD与RCA（r = 0.79，P <.001）、LAD与LCx（r = 0.61，P <.001）以及LCx与RCA（r = 0.57，P <.001）之间的CFR存在适度相关性。对所有患者同时比较3支冠状动脉的CFR表明，LCx的值显著低于RCA和LAD分布区域。
有胸痛且无CAD的女性冠状动脉分布区域微血管功能分类存在显著不一致，提示微血管功能障碍在心肌中呈异质性分布。心脏导管检查时对单支冠状动脉CFR的评估可能无法准确评估无CAD的胸痛女性的冠状动脉微循环。
