Muroya Takahiro, Kawano Hiroaki, Koga Seiji, Ikeda Satoshi, Yamamoto Fumi, Miwa Takashi, Kohno Yusuke, Maemura Koji
Department of Cardiology, Ureshino Medical Center.
Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences.
Int Heart J. 2018 Nov 28;59(6):1194-1201. doi: 10.1536/ihj.17-459. Epub 2018 Oct 10.
The consumption of omega-3 polyunsaturated fatty acids (PUFAs) reduces the incidence of cardiovascular events and sudden cardiac death. Coronary microvascular dysfunction (CMD) is a predictor of cardiac mortality, but little information is known on the relationship between CMD and omega-3 PUFAs. This study aimed to identify the relationship between the serum levels of omega-3 PUFAs and the CMD evaluated by the hyperemic microvascular resistance index (hMVRI) to assess coronary microvascular function in patients with stable coronary artery disease (CAD).Intracoronary physiological variables (fractional flow reserve (FFR), hMVRI, mean distal coronary pressure (Pd), and average peak velocity (APV)) were measured in 108 patients. These parameters were evaluated in 150 coronary arteries with stenosis of intermediate severity and without significant ischemia (FFR > 0.80). The PUFA levels and atherosclerotic risk factors were also measured. Univariate analysis shows that hMVRI was negatively correlated with eicosapentaenoic acid (EPA)/arachidonic acid (AA) ratio (β = -0.31, P = 0.001) and EPA (β = -0.25, P = 0.009) and was positively correlated with dihomo-γ-linolenic acid (β = 0.26, P = 0.006). Multivariate regression analysis shows that the EPA/AA ratio was the only independent determinant of hMVRI (β = -0.234, SE = 0.231, P = 0.024). Furthermore, hMVRI decreased significantly from the lowest to highest tertiles of the EPA/AA ratio (P = 0.007). The EPA/AA ratio was positively correlated with APV at hyperemia (β = 0.26, P = 0.008) but not with Pd at hyperemia.A lower serum EPA/AA ratio may cause CMD in patients with stable CAD.
摄入ω-3多不饱和脂肪酸（PUFAs）可降低心血管事件和心源性猝死的发生率。冠状动脉微血管功能障碍（CMD）是心脏死亡率的一个预测指标，但关于CMD与ω-3 PUFAs之间的关系知之甚少。本研究旨在确定ω-3 PUFAs的血清水平与通过充血微血管阻力指数（hMVRI）评估的CMD之间的关系，以评估稳定型冠状动脉疾病（CAD）患者的冠状动脉微血管功能。对108例患者进行了冠状动脉内生理变量（血流储备分数（FFR）、hMVRI、冠状动脉远端平均压力（Pd）和平均峰值速度（APV））的测量。在150支中度狭窄且无明显缺血（FFR>0.80）的冠状动脉中对这些参数进行了评估。还测量了PUFA水平和动脉粥样硬化危险因素。单因素分析显示，hMVRI与二十碳五烯酸（EPA）/花生四烯酸（AA）比值（β=-0.31，P=0.001）和EPA（β=-0.25，P=0.009）呈负相关，与二高-γ-亚麻酸呈正相关（β=0.26，P=0.006）。多因素回归分析显示，EPA/AA比值是hMVRI的唯一独立决定因素（β=-0.234，标准误=0.231，P=0.024）。此外，hMVRI从EPA/AA比值的最低三分位数到最高三分位数显著降低（P=0.007）。EPA/AA比值与充血时的APV呈正相关（β=0.26，P=0.008），但与充血时的Pd无关。较低的血清EPA/AA比值可能导致稳定型CAD患者出现CMD。
