Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Radiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
J Am Coll Cardiol. 2016 Mar 29;67(12):1412-1422. doi: 10.1016/j.jacc.2016.01.013.
Although a common symptom in patients with severe aortic stenosis (AS) without obstructive coronary artery disease (CAD), little is known about the pathogenesis of exertional angina.
This study sought to prove that microvascular dysfunction is responsible for chest pain in patients with severe AS and normal epicardial coronary arteries using adenosine-stress cardiac magnetic resonance (CMR) imaging.
Between June 2012 and April 2015, 117 patients with severe AS without obstructive CAD and 20 normal controls were enrolled prospectively. After exclusions, study patients were divided into 2 groups according to presence of exertional chest pain: an angina group (n = 43) and an asymptomatic group (n = 41), and the semiquantitative myocardial perfusion reserve index (MPRI) was calculated.
MPRI values were significantly lower in severe AS patients than in normal controls (0.90 ± 0.31 vs. 1.25 ± 0.21; p < 0.001), and were much lower in the angina group than the asymptomatic group (0.74 ± 0.25 vs. 1.08 ± 0.28; p < 0.001). In logistic regression analysis, the only independent predictor for angina was MPRI (odds ratio: 0.003; p < 0.001). Univariate associations with MPRI were identified for diastolic blood pressure, E/e' ratio, left ventricular volume and ejection fraction, cardiac index, presence of late gadolinium enhancement, and left ventricular mass index (LVMI). In multivariate analysis, LVMI was the strongest contributing factor to MPRI (standardization coefficient: -0.428; p < 0.001).
Our results suggest that, in patients with severe AS without obstructive CAD, angina is related to impaired coronary microvascular function along with LV hypertrophy detectable by semiquantitative MPRI using adenosine-stress CMR.
NCT02575768.
尽管在没有阻塞性冠状动脉疾病（CAD）的严重主动脉瓣狭窄（AS）患者中，劳力性心绞痛是一种常见症状，但对于其发病机制却知之甚少。
本研究旨在通过腺苷负荷心脏磁共振（CMR）成像，证明微血管功能障碍是导致严重 AS 且正常心外膜冠状动脉患者胸痛的原因。
2012 年 6 月至 2015 年 4 月，前瞻性纳入 117 例严重 AS 且无阻塞性 CAD 患者和 20 例正常对照者。排除后，根据是否存在劳力性胸痛，将研究患者分为两组：心绞痛组（n = 43）和无症状组（n = 41），并计算半定量心肌灌注储备指数（MPRI）。
与正常对照组相比，严重 AS 患者的 MPRI 值明显较低（0.90 ± 0.31 比 1.25 ± 0.21；p < 0.001），且心绞痛组明显低于无症状组（0.74 ± 0.25 比 1.08 ± 0.28；p < 0.001）。在逻辑回归分析中，唯一的独立预测因子是 MPRI（比值比：0.003；p < 0.001）。与 MPRI 相关的单变量因素有舒张压、E/e' 比值、左心室容积和射血分数、心指数、晚期钆增强和左心室质量指数（LVMI）。多变量分析显示，LVMI 是 MPRI 的最强影响因素（标准化系数：-0.428；p < 0.001）。
我们的研究结果表明，在严重 AS 且无阻塞性 CAD 的患者中，心绞痛与冠状动脉微血管功能受损有关，而 LV 肥厚则可通过腺苷负荷 CMR 检测到半定量 MPRI。
NCT02575768。
