Institute of Cardiology, Università Cattolica del Sacro Cuore, Roma, Italy.
Int J Cardiol. 2013 Sep 20;168(1):121-5. doi: 10.1016/j.ijcard.2012.09.059. Epub 2012 Oct 8.
We assessed whether exercise stress test (EST) results are related to the presence of coronary microvascular dysfunction (CMVD) in patients undergoing elective percutaneous coronary intervention (PCI).
Previous studies showed that EST is poorly reliable in predicting restenosis after PCI; some studies also showed CMVD in the territory of the treated vessel.
We studied 29 patients (age 64 ± 6, 23 M) with stable coronary artery disease and isolated stenosis (>75%) of the left anterior descending (LAD) coronary artery, undergoing successful PCI with stent implantation. EST and assessment of coronary microvascular function were performed 24h, 3 months and 6 months after PCI. Coronary blood flow (CBF) response to adenosine and to cold-pressor test (CPT) was assessed in the LAD coronary artery by transthoracic Doppler echocardiography.
Patients with ST-segment depression ≥ 1 mm at EST performed 24h after PCI (n=11, 38%) showed a lower CBF response to adenosine compared to those with negative EST (1.65 ± 0.4 vs. 2.11 ± 0.4, respectively, p=0.003), whereas the difference in CBF response to CPT was not significant (1.44 ± 0.4 vs. 1.64 ± 0.3, respectively; p=0.11). At 3-month and 6-month follow-up a positive EST was found in 12 (41%) and 13 (44%) patients, respectively; patients with positive EST also had lower CBF response to adenosine compared to those with negative EST (3 months: 1.69 ± 0.3 vs. 2.20 ± 0.3, respectively; 6 months: 1.66 ± 0.2 vs. 2.32 ± 0.3, respectively; p<0.001 for both).
Positive EST after elective successful PCI consistently reflects impairment of hyperemic CBF due to CMVD, which persists over a follow-up period of 6 months.
我们评估了运动负荷试验（EST）结果是否与择期经皮冠状动脉介入治疗（PCI）患者的冠状动脉微血管功能障碍（CMVD）有关。
先前的研究表明，EST 在预测 PCI 后再狭窄方面的可靠性较差；一些研究还显示在治疗血管的区域存在 CMVD。
我们研究了 29 名年龄为 64±6 岁、男性 23 名的稳定性冠心病患者，这些患者的左前降支（LAD）冠状动脉存在孤立性狭窄（>75%），并成功进行了 PCI 支架植入术。在 PCI 后 24 小时、3 个月和 6 个月进行 EST 和冠状动脉微血管功能评估。通过经胸多普勒超声心动图评估 LAD 冠状动脉腺苷和冷加压试验（CPT）时的冠状动脉血流（CBF）反应。
在 PCI 后 24 小时 EST 出现 ST 段压低≥1mm 的患者（n=11，38%）与 EST 阴性患者相比，腺苷引起的 CBF 反应较低（分别为 1.65±0.4 比 2.11±0.4，p=0.003），而 CPT 引起的 CBF 反应差异无统计学意义（分别为 1.44±0.4 比 1.64±0.3，p=0.11）。在 3 个月和 6 个月的随访中，分别有 12 名（41%）和 13 名（44%）患者出现阳性 EST；与 EST 阴性患者相比，阳性 EST 患者的腺苷引起的 CBF 反应也较低（3 个月：1.69±0.3 比 2.20±0.3，p<0.001；6 个月：1.66±0.2 比 2.32±0.3，p<0.001）。
择期成功 PCI 后出现阳性 EST 一致反映了由于 CMVD 导致的充血性 CBF 受损，这种情况在 6 个月的随访期间持续存在。
