AlBadri Ahmed, Wei Janet, Mehta Puja K, Landes Sofy, Petersen John W, Anderson R David, Samuels Bruce, Azarbal Babak, Handberg Eileen M, Li Quanlin, Minissian Margo, Shufelt Chrisandra, Pepine Carl J, Bairey Merz C Noel
Cedars-Sinai Heart Institute, Los Angeles, California, United States of America.
Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, United States of America.
PLoS One. 2017 Feb 16;12(2):e0172538. doi: 10.1371/journal.pone.0172538. eCollection 2017.
Assessment of coronary endothelial function with intracoronary acetylcholine (IC-Ach) provides diagnostic and prognostic data in patients with suspected coronary microvascular dysfunction (CMD), but is often not feasible due in part to the time and expertise needed for pharmacologic mixing. Cold pressor testing (CPT) is a simple and safe stimulus useful for either invasive or non-invasive endothelial function testing and myocardial perfusion imaging but has not been specifically evaluated among symptomatic women with signs of ischemic heart disease (IHD) who have no obstructive coronary artery disease (CAD).
163 women with signs and symptoms of IHD and no obstructive CAD from the NHLBI- Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study underwent coronary reactivity testing with a Doppler flow wire (FloWire® Volcano, San Diego, CA) in the proximal left anterior descending artery. Coronary artery diameter and coronary blood flow (CBF) assessed by core lab using QCA before and after IC-Ach (18.2 μg/ml infused over 3 minutes) and during CPT.
Mean age was 55 ± 12 years. Rate pressure product (RPP) in response to IC-Ach did not change (baseline to peak, P = 0.26), but increased during CPT (363±1457; P = 0.0028). CBF in response to CPT was poorly correlated to IC-Ach CBF. Change in coronary artery diameter after IC-Ach correlated with change after CPT (r = 0.59, P<0.001). The correlation coefficient was stronger in subjects with coronary dilation to IC-Ach (r = 0.628, P<0.001) versus those without dilation (r = 0.353, P = 0.002), suggesting that other factors may be important to this relationship when endothelium is abnormal.
In women with no obstructive CAD and suspected CMD, coronary diameter changes with IC-Ach and CPT are moderately-well correlated suggesting that CPT testing may be of some use, particularly among patients with normal endothelial function, however, not an alternative to IC-Ach for diagnosis of coronary endothelial dysfunction.
使用冠状动脉内乙酰胆碱（IC-Ach）评估冠状动脉内皮功能可为疑似冠状动脉微血管功能障碍（CMD）的患者提供诊断和预后数据，但部分由于药物混合所需的时间和专业知识，该方法往往不可行。冷加压试验（CPT）是一种简单且安全的刺激方法，可用于有创或无创的内皮功能测试及心肌灌注成像，但尚未在无阻塞性冠状动脉疾病（CAD）却有缺血性心脏病（IHD）体征的有症状女性中进行专门评估。
来自美国国立心肺血液研究所（NHLBI）的女性缺血综合征评估-冠状动脉血管功能障碍（WISE-CVD）研究中的163名有IHD体征和症状且无阻塞性CAD的女性，在左前降支近端使用多普勒血流导丝（FloWire® Volcano，加利福尼亚州圣地亚哥）进行冠状动脉反应性测试。核心实验室在IC-Ach（3分钟内输注18.2μg/ml）前后及CPT期间，使用定量冠状动脉造影（QCA）评估冠状动脉直径和冠状动脉血流（CBF）。
平均年龄为55±12岁。对IC-Ach反应的心率血压乘积（RPP）无变化（基线至峰值，P = 0.26），但在CPT期间升高（363±1457；P = 0.0028）。CPT反应的CBF与IC-Ach CBF相关性较差。IC-Ach后冠状动脉直径变化与CPT后变化相关（r = 0.59，P<0.001）。与无扩张者（r = 0.353，P = 0.002）相比，对IC-Ach有冠状动脉扩张者的相关系数更强（r = 0.628，P<0.001），这表明当内皮异常时，其他因素可能对这种关系很重要。
在无阻塞性CAD且疑似CMD的女性中，IC-Ach和CPT引起的冠状动脉直径变化有中度良好的相关性，提示CPT测试可能有一定作用，特别是在内皮功能正常的患者中，然而，CPT不能替代IC-Ach用于诊断冠状动脉内皮功能障碍。
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