心肌血流储备在主动脉瓣钙化且心外膜冠状动脉无阻塞的患者中受损。
Myocardial blood flow reserve is impaired in patients with aortic valve calcification and unobstructed epicardial coronary arteries.
机构信息
Department of Cardiology, Poole Hospital NHS Foundation Trust, Centre for Postgraduate Medical Research and Education, Bournemouth University, Dorset, UK.
Department of Cardiology, Sunshine Coast Hospital and Health Services, University of the Sunshine Coast and University of Queensland, Queensland, Australia.
出版信息
Int J Cardiol. 2017 Dec 1;248:427-432. doi: 10.1016/j.ijcard.2017.06.023. Epub 2017 Jun 15.
BACKGROUND
Although calcific aortic valve disease (CAVD) is associated with coronary atherosclerosis, it is not known whether early CAVD is associated with coronary microcirculatory dysfunction (CMD). We sought to investigate the relationship between myocardial blood flow reserve (MBFR) - a measure of CMD, and early CAVD in the absence of obstructive epicardial coronary artery disease. We also determined whether this relationship was independent of coronary artery disease (CAD) and hs-CRP, a marker of systemic inflammation.
METHODS
183 patients with chest pain and unobstructed coronary arteries were studied. Aortic valve calcification score (AVCS), coronary total plaque length (TPL), and coronary calcium score were quantified from multislice CT. MBFR was assessed using vasodilator myocardial contrast echocardiography. Hs-CRP was measured from venous blood using a particle-enhanced immunoassay.
RESULTS
Mean (±SD) participant age was 59.8 (9.6) years. Mean AVCS was 68 (258) AU, TPL was 15.6 (22.2) mm, and median coronary calcification score was 43.5AU. Mean MBFR was 2.20 (0.52). Mean hs-CRP was 2.52 (3.86) mg/l. Multivariable linear regression modelling incorporating demographics, coronary plaque characteristics, MBFR, and inflammatory markers, demonstrated that age (β=0.05, 95% CI: 0.02, 0.08, P=0.007), hs-CRP (β=0.09, CI: 0.02, 0.16, P=0.010) and diabetes (β=1.03, CI: 0.08, 1.98, P=0.033), were positively associated with AVCS. MBFR (β=-0.87, CI: -1.44, -0.30, P=0.003), BMI (β=-0.11, CI: -0.21, -0.01, P=0.033), and LDL (β=-0.32, CI: -0.61, -0.03, P=0.029) were negatively associated with AVCS. TPL and coronary calcium score were not independently associated with AVCS when included in the regression model.
CONCLUSION
Coronary microvascular function as determined by measurement of myocardial blood flow reserve is independently associated with early CAVD. This effect is independent of the presence of coronary artery disease and also systemic inflammation.
背景
尽管钙化性主动脉瓣疾病（CAVD）与冠状动脉粥样硬化有关，但尚不清楚早期 CAVD 是否与冠状动脉微循环功能障碍（CMD）有关。我们试图研究心肌血流储备（MBFR） - CMD 的一种测量方法 - 在没有阻塞性冠状动脉粥样硬化的情况下与早期 CAVD 的关系。我们还确定了这种关系是否独立于冠状动脉疾病（CAD）和 hs-CRP，hs-CRP 是全身炎症的标志物。
方法
研究了 183 名胸痛且冠状动脉无阻塞的患者。从多层 CT 中定量评估主动脉瓣钙化评分（AVCS）、冠状动脉总斑块长度（TPL）和冠状动脉钙评分。使用血管扩张性心肌对比超声心动图评估 MBFR。使用颗粒增强免疫测定法从静脉血中测量 hs-CRP。
结果
平均（±SD）参与者年龄为 59.8（9.6）岁。平均 AVCS 为 68（258）AU，TPL 为 15.6（22.2）mm，中位数冠状动脉钙化评分 43.5AU。平均 MBFR 为 2.20（0.52）。平均 hs-CRP 为 2.52（3.86）mg/L。多变量线性回归模型纳入人口统计学、冠状动脉斑块特征、MBFR 和炎症标志物，结果表明年龄（β=0.05，95%CI：0.02，0.08，P=0.007）、hs-CRP（β=0.09，CI：0.02，0.16，P=0.010）和糖尿病（β=1.03，CI：0.08，1.98，P=0.033）与 AVCS 呈正相关。MBFR（β=-0.87，CI：-1.44，-0.30，P=0.003）、BMI（β=-0.11，CI：-0.21，-0.01，P=0.033）和 LDL（β=-0.32，CI：-0.61，-0.03，P=0.029）与 AVCS 呈负相关。当将 TPL 和冠状动脉钙评分纳入回归模型时，它们与 AVCS 没有独立的相关性。
结论
通过测量心肌血流储备来确定的冠状动脉微血管功能与早期 CAVD 独立相关。这种作用独立于冠状动脉疾病的存在，也独立于全身炎症。
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