From the Division of Cardiovascular Medicine, Stanford University, CA (Y.K., W.F.F., T.N., D.-H.C.); Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea (J.M.L.); Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea (J.H.L.); Department of Cardiology, Catharina Hospital Eindhoven, the Netherlands (F.M.Z.); Department of Medicine, Seoul National University Hospital, Republic of Korea (J.-H.J., H.-J.L., B.-K.K.); Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea (J.-H.D.); Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea (C.-W.N.); Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Republic of Korea (E.-S.S.); and Institute of Aging, Seoul National University, Republic of Korea (B.-K.K.).
Circ Cardiovasc Interv. 2017 Nov;10(11). doi: 10.1161/CIRCINTERVENTIONS.117.005445.
Difficulty directly visualizing the coronary microvasculature as opposed to the epicardial coronary artery makes its assessment challenging. The goal of this study is to measure the index of microcirculatory resistance (IMR) in all 3 major coronary vessels to identify the clinical and angiographic predictors of an abnormal IMR.
Ninety-three patients who underwent coronary physiological assessment in all 3 major coronary vessels were prospectively enrolled (59.8±9.4 years with 77.4% men). IMR was corrected using Yong's formula and coronary microvascular dysfunction (CMD) was defined using vessel-specific cutoffs. A global IMR was calculated as the sum of the IMR in all 3 major epicardial vessels. Angiographic epicardial disease severity was assessed with vessel-specific and overall SYNTAX score. Median IMR and fractional flow reserve was 17.2 (Q1-Q3: 13.3-22.9) and 0.92 (0.85-0.97). The majority of patients (59.1%) had no CMD, 23.7% had 1-vessel CMD, 14.0% had 2-vessel CMD, and 3.2% had 3-vessel CMD. CMD was observed at a similar rate in the territories supplied by all 3 major coronary vessels (left anterior descending coronary artery 28.0%, left circumflex artery 19.4%, and right coronary artery 23.7%; =0.39). Fractional flow reserve had a weak, positive correlation with IMR (ρ=0.16; <0.01). The SYNTAX score had no significant correlation with IMR, both at a patient level (ρ=-0.002; =0.99) and a vessel-specific level (ρ=-0.06; =0.36). By multivariable ordinal logistic regression analysis, no variable was left as an independent predictor of an abnormal IMR.
Clinical factors and epicardial coronary disease severity are not predictors of the extent of CMD.
URL: https://www.clinicaltrials.gov. Unique identifier: NCT01621438.
与心外膜冠状动脉相比，冠状动脉微血管较难直接可视化，这使得其评估具有挑战性。本研究的目的是测量所有 3 大冠状动脉的微血管阻力指数（IMR），以确定异常 IMR 的临床和血管造影预测因素。
前瞻性纳入 93 例在所有 3 大冠状动脉均接受冠状动脉生理评估的患者（59.8±9.4 岁，77.4%为男性）。采用 Yong 公式校正 IMR，并使用特定血管的截止值定义冠状动脉微血管功能障碍（CMD）。计算 3 大心外膜冠状动脉的 IMR 总和作为总体 IMR。采用特定血管和整体 SYNTAX 评分评估血管造影心外膜疾病严重程度。中位 IMR 和血流储备分数分别为 17.2（Q1-Q3：13.3-22.9）和 0.92（0.85-0.97）。大多数患者（59.1%）无 CMD，23.7%有 1 支血管 CMD，14.0%有 2 支血管 CMD，3.2%有 3 支血管 CMD。CMD 在由所有 3 大冠状动脉供血的区域中发生率相似（左前降支冠状动脉 28.0%，左回旋支冠状动脉 19.4%，右冠状动脉 23.7%；=0.39）。血流储备分数与 IMR 呈弱正相关（ρ=0.16；<0.01）。SYNTAX 评分与 IMR 无显著相关性，无论是在患者水平（ρ=-0.002；=0.99）还是在特定血管水平（ρ=-0.06；=0.36）。多变量有序逻辑回归分析显示，无变量作为异常 IMR 的独立预测因素。
临床因素和心外膜冠状动脉疾病严重程度不是 CMD 程度的预测因素。
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