无阻塞性冠状动脉疾病患者复发性胸痛的临床和冠状动脉血流动力学决定因素——一项初步研究。

Clinical and coronary haemodynamic determinants of recurrent chest pain in patients without obstructive coronary artery disease - A pilot study.

机构信息

Discipline of Medicine, University of Adelaide, Adelaide, South Australia 5005, Australia; Cardiology Department, The Queen Elizabeth & Royal Adelaide Hospitals, Central Adelaide Local Health Network, Adelaide, South Australia, Australia; Basil Hetzel Institute for Translational Health Research, 37 Woodville Road, Woodville South, South Australia 5011, Australia.

Discipline of Medicine, University of Adelaide, Adelaide, South Australia 5005, Australia; Cardiology Department, The Queen Elizabeth & Royal Adelaide Hospitals, Central Adelaide Local Health Network, Adelaide, South Australia, Australia; Cardiology Unit, Lyell McEwin Hospital, Northern Adelaide Local Health Network, Haydown Road, Elizabeth Vale, South Australia 5112, Australia.

出版信息

Int J Cardiol. 2018 Sep 15;267:16-21. doi: 10.1016/j.ijcard.2018.04.077.

DOI:10.1016/j.ijcard.2018.04.077

PMID:29957255

Abstract

BACKGROUND

Coronary haemodynamic testing frequently identifies abnormal pathophysiological parameters in patients with angina and non-obstructed coronaries on angiography (NoCAD) but the clinical utility of these measures has received limited attention.

OBJECTIVE

This study aims to identify the clinical and coronary haemodynamic determinants of recurrent chest pain at one month in patients with NoCAD.

METHODS

Patients with angina, NoCAD (<50% stenosis) and normal LV systolic function underwent invasive coronary haemodynamic testing involving: (1) angiographic TIMI frame and opacification rate, (2) microvascular functional measures including coronary flow reserve (CFR) and hyperaemic microvascular resistance (HMR), (3) coronary endothelial function assessment with low dose intracoronary acetylcholine (IC-ACh) infusions (0.18 μg/min & 1.8 μg/min over 2 min), and (4) Provocative spasm testing with high dose IC-ACh boluses (25, 50 and 100 μg). Clinical and health status were assessed at baseline and one month.

RESULTS

In the 49 NoCAD patients (78% female, mean age of 54 ± 11) undergoing comprehensive coronary haemodynamic testing, 33 (67%) continued to experience chest pain at one month. Determinants of recurrent chest pain on univariate analysis included baseline chest pain status or a HMR > 1.9. Multivariate logistic regression analysis identified frequent angina at baseline (OR: 68.9 [4.1, 1165.0], p = 0.003), previous unstable angina admission (OR: 43.9 [3.5, 547.9], p = 0.003) and a HMR > 1.9 (OR: 15.6 [2.1, 114.0], p = 0.007) as independent predictors of recurrent chest pain.

CONCLUSION

In this small pilot study, an abnormal HMR was the only coronary haemodynamic parameter that was a determinant of ongoing angina at short-term follow-up.

摘要

背景

在冠状动脉造影显示无阻塞性冠状动脉病变（NoCAD）但存在心绞痛的患者中，冠状动脉血流动力学检测常可识别异常的病理生理参数，但这些检测的临床应用价值尚未得到广泛关注。

目的

本研究旨在确定 NoCAD 患者在 1 个月时反复发作胸痛的临床和冠状动脉血流动力学决定因素。

方法

有胸痛、NoCAD（狭窄<50%）和正常左心室收缩功能的患者接受了包括以下内容的侵入性冠状动脉血流动力学检测：（1）血管造影 TIMI 帧数和充盈率；（2）微血管功能指标，包括冠状动脉血流储备（CFR）和充血性微血管阻力（HMR）；（3）使用低剂量冠状动脉内乙酰胆碱（IC-ACh）输注（0.18μg/min 和 1.8μg/min 各 2 分钟）评估冠状动脉内皮功能；（4）用高剂量 IC-ACh 推注（25、50 和 100μg）进行激发性痉挛检测。在基线和 1 个月时评估临床和健康状况。

结果

在 49 名接受全面冠状动脉血流动力学检测的 NoCAD 患者（78%为女性，平均年龄为 54±11 岁）中，33 名（67%）在 1 个月时仍有胸痛。单因素分析中，复发性胸痛的决定因素包括基线胸痛状态或 HMR>1.9。多变量逻辑回归分析确定基线时频繁出现心绞痛（OR：68.9[4.1，1165.0]，p=0.003）、既往不稳定型心绞痛入院（OR：43.9[3.5，547.9]，p=0.003）和 HMR>1.9（OR：15.6[2.1，114.0]，p=0.007）是复发性胸痛的独立预测因素。