Kato Shingo, Saito Naka, Kirigaya Hidekuni, Gyotoku Daiki, Iinuma Naoki, Kusakawa Yuka, Iguchi Kohei, Nakachi Tatsuya, Fukui Kazuki, Futaki Masaaki, Iwasawa Tae, Kimura Kazuo, Umemura Satoshi
Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, MA
Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan.
J Am Heart Assoc. 2016 Feb 23;5(2):e002649. doi: 10.1161/JAHA.115.002649.
Phase contrast (PC) cine-magnetic resonance imaging (MRI) of the coronary sinus allows for noninvasive evaluation of coronary flow reserve (CFR), which is an index of left ventricular microvascular function. The objective of this study was to investigate coronary flow reserve in patients with heart failure with preserved ejection fraction (HFpEF).
We studied 25 patients with HFpEF (mean and SD of age: 73±7 years), 13 with hypertensive left ventricular hypertrophy (LVH) (67±10 years), and 18 controls (65±15 years). Breath-hold PC cine-MRI images of the coronary sinus were obtained to assess blood flow at rest and during ATP infusion. CFR was calculated as coronary sinus blood flow during ATP infusion divided by coronary sinus blood flow at rest. Impairment of CFR was defined as CFR <2.5 according to a previous study. The majority (76%) of HFpEF patients had decreased CFR. CFR was significantly decreased in HFpEF patients in comparison to hypertensive LVH patients and control subjects (CFR: 2.21±0.55 in HFpEF vs 3.05±0.74 in hypertensive LVH, 3.83±0.73 in controls; P<0.001 by 1-way ANOVA). According to multivariable linear regression analysis, CFR independently and significantly correlated with serum brain natriuretic peptide level (β=-68.0; 95% CI, -116.2 to -19.7; P=0.007).
CFR was significantly lower in patients with HFpEF than in hypertensive LVH patients and controls. These results indicated that impairment of CFR might be a pathophysiological factor for HFpEF and might be related to HFpEF disease severity.
冠状动脉窦的相位对比（PC）电影磁共振成像（MRI）可对冠状动脉血流储备（CFR）进行无创评估，CFR是左心室微血管功能的一个指标。本研究的目的是调查射血分数保留的心力衰竭（HFpEF）患者的冠状动脉血流储备。
我们研究了25例HFpEF患者（年龄均值和标准差：73±7岁）、13例高血压性左心室肥厚（LVH）患者（67±10岁）和18例对照者（65±15岁）。获取屏气状态下冠状动脉窦的PC电影MRI图像，以评估静息状态和ATP输注期间的血流。CFR计算为ATP输注期间冠状动脉窦血流量除以静息状态下冠状动脉窦血流量。根据先前的一项研究，CFR受损定义为CFR<2.5。大多数（76%）HFpEF患者的CFR降低。与高血压LVH患者和对照者相比，HFpEF患者的CFR显著降低（CFR：HFpEF患者为2.21±0.55，高血压LVH患者为3.05±0.74，对照者为3.83±0.73；单因素方差分析P<0.001）。根据多变量线性回归分析，CFR与血清脑钠肽水平独立且显著相关（β=-68.0；95%CI，-116.2至-19.7；P=0.007）。
HFpEF患者的CFR显著低于高血压LVH患者和对照者。这些结果表明，CFR受损可能是HFpEF的一个病理生理因素，且可能与HFpEF疾病严重程度相关。
