Division of Cardiovascular Diseases, Mayo College of Medicine, Rochester, Minnesota.
Division of Biomedical Statistics and Informatics, Mayo College of Medicine, Rochester, Minnesota.
JACC Cardiovasc Interv. 2015 Sep;8(11):1445-1453. doi: 10.1016/j.jcin.2015.06.017.
This study assessed the prevalence of coronary microvascular abnormalities in patients presenting with chest pain and nonobstructive coronary artery disease (CAD).
Coronary microvascular abnormalities mediate ischemia and can lead to an increased risk of cardiovascular events.
Using an intracoronary Doppler guidewire, endothelial-dependent microvascular function was examined by evaluating changes in coronary blood flow in response to acetylcholine, whereas endothelial-independent microvascular function was examined by evaluating changes in coronary flow velocity reserve in response to intracoronary adenosine. Patients were divided into 4 groups depending on whether they had a normal (+) or abnormal (-) coronary blood flow (CBF) in response to acetylcholine (Ach) and a normal (+) or abnormal (-) coronary flow velocity reserve (CFR) in response to adenosine (Adn): CBFAch+, CFRAdn+ (n = 520); CBFAch-, CFRAdn+ (n = 478); CBFAch+, CFRAdn- (n = 173); and CBFAch-, CFRAdn- (n = 268).
Two-thirds of all patients had some sort of microvascular dysfunction. Women were more prevalent in each group (56% to 82%). Diabetes was uncommon in all groups (7% to 12%), whereas hypertension and hyperlipidemia were relatively more prevalent in each group, although rates for most conventional cardiovascular risk factors did not differ significantly between groups. There were no significant differences in the findings of noninvasive functional testing between groups. In a multivariable analysis, age was the only variable that independently predicted abnormal microvascular function.
Patients with chest pain and nonobstructive CAD have a high prevalence of coronary microvascular abnormalities. These abnormalities correlate poorly with conventional cardiovascular risk factors and are dissociated from the findings of noninvasive functional testing.
本研究评估了胸痛和非阻塞性冠状动脉疾病（CAD）患者中冠状动脉微血管异常的发生率。
冠状动脉微血管异常介导缺血，并可导致心血管事件风险增加。
使用冠状动脉内多普勒导丝，通过评估乙酰胆碱引起的冠状动脉血流变化来评估内皮依赖性微血管功能，通过评估腺苷引起的冠状动脉血流速度储备变化来评估内皮非依赖性微血管功能。根据乙酰胆碱（Ach）反应中是否存在正常（+）或异常（-）冠状动脉血流（CBF）以及腺苷（Adn）反应中是否存在正常（+）或异常（-）冠状动脉血流速度储备（CFR），将患者分为 4 组：CBFAch+，CFRAdn+（n=520）；CBFAch-，CFRAdn+（n=478）；CBFAch+，CFRAdn-（n=173）；CBFAch-，CFRAdn-（n=268）。
所有患者中有三分之二存在某种程度的微血管功能障碍。每个组中女性的比例均较高（56%至 82%）。所有组中糖尿病均不常见（7%至 12%），而高血压和高脂血症在每个组中相对更为常见，尽管大多数传统心血管危险因素的发生率在组间无显著差异。各组间无创性功能检查结果无显著差异。多变量分析显示，年龄是唯一独立预测异常微血管功能的变量。
胸痛和非阻塞性 CAD 患者中冠状动脉微血管异常的发生率较高。这些异常与传统心血管危险因素相关性差，与无创性功能检查结果无关。
