Division of Cardiology and Pediatric Cardiology, Departments of Internal Medicine and Pediatrics, University of Nebraska Medical Center, Omaha, NE.
Circ Cardiovasc Imaging. 2018 Oct;11(10):e007483. doi: 10.1161/CIRCIMAGING.117.007483.
Our aim was to determine the cardiovascular outcome of patients with capillary blood flow (CBF) abnormalities detected during demand stress in the absence of obstructive coronary artery disease.
We identified 380 consecutive patients referred for coronary angiography (CA) after dobutamine or exercise stress echocardiography (SE) between 2008 and 2013 performed with real-time perfusion imaging to examine myocardial CBF with a continuous ultrasound contrast infusion. Patients with left ventricular ejection fraction <40% were excluded. There were 3 groups based on results: positive SE/negative CA, patients who had abnormal regional CBF but no significant angiographic disease; positive SE/positive CA, those with abnormal CBF and significant disease on subsequent CA; and negative SE/negative CA, patients with normal CBF and negative CA. Event-free survival examining death and nonfatal myocardial infarction was compared. Median follow-up was 4 years. There were 91 positive SE/negative CA, 189 positive SE/positive CA, and 100 negative SE/negative CA patients over the study period. The positive SE/negative CA patients were more frequently women and had a lower prevalence of hypertension and hyperlipidemia (all P<0.001). Analysis of event-free survival with Cox regression demonstrated that death/nonfatal myocardial infarction rates were higher in the positive SE/positive CA (hazard ratio, 2.10; CI, 1.02-4.29) and positive SE/negative CA (hazard ratio, 2.02; CI, 0.99-4.31) groups when compared with negative SE/negative CA groups.
Patients with inducible CBF abnormalities in the absence of significant obstructive disease at CA still have similar death/nonfatal myocardial infarction rates as those with significant disease at CA.
我们的目的是确定在不存在阻塞性冠状动脉疾病的情况下，在需求应激期间检测到毛细血管血流（CBF）异常的患者的心血管结局。
我们在 2008 年至 2013 年间识别了 380 例连续患者，这些患者在多巴酚丁胺或运动超声心动图（SE）后因冠状动脉造影（CA）而被转诊，SE 采用实时灌注成像进行，用连续超声对比输注检查心肌 CBF。排除左心室射血分数<40%的患者。根据结果分为 3 组：SE 阳性/CA 阴性，患者存在区域性 CBF 异常但无明显血管造影疾病；SE 阳性/CA 阳性，患者存在异常 CBF 和随后 CA 上的显著疾病；SE 阴性/CA 阴性，患者 CBF 正常且 CA 阴性。比较检查死亡和非致死性心肌梗死的无事件生存。中位随访时间为 4 年。在研究期间，有 91 例 SE 阳性/CA 阴性，189 例 SE 阳性/CA 阳性和 100 例 SE 阴性/CA 阴性患者。SE 阳性/CA 阴性患者更常见为女性，且高血压和高血脂的患病率较低（均 P<0.001）。Cox 回归分析无事件生存显示，与 SE 阴性/CA 阴性组相比，SE 阳性/CA 阳性（危险比，2.10；CI，1.02-4.29）和 SE 阳性/CA 阴性（危险比，2.02；CI，0.99-4.31）组的死亡率/非致死性心肌梗死率更高。
在 CA 中不存在显著阻塞性疾病的情况下，诱导性 CBF 异常患者的死亡率/非致死性心肌梗死率与 CA 中存在显著疾病的患者相似。
