Department of Clinical Science, University of Bergen, Bergen, Norway.
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Open Heart. 2019 May 4;6(1):e000981. doi: 10.1136/openhrt-2018-000981. eCollection 2019.
High aortic stiffness may reduce myocardial perfusion pressure and contribute to development of myocardial ischaemia. Whether high aortic stiffness is associated with myocardial ischaemia in patients with stable angina and non-obstructive coronary artery disease (CAD) is less explored.
Aortic stiffness was assessed as carotid-femoral pulse wave velocity (PWV) by applanation tonometry in 125 patients (62±8 years, 58% women) with stable angina and non-obstructive CAD participating in the Myocardial Ischemia in Non-obstructive CAD project. PWV in the highest tertile (>8.7 m/s) was taken as higher aortic stiffness. Stress-induced myocardial ischaemia was detected as delayed myocardial contrast replenishment during stress echocardiography, and the number of left ventricular (LV) segments with delayed contrast replenishment as the extent of ischaemia.
Patients with higher aortic stiffness were older with higher LV mass index and lower prevalence of obesity (all p<0.05), while angina symptoms, sex, prevalence of hypertension, diabetes, smoking or LV ejection fraction did not differ between groups. Stress-induced myocardial ischaemia was more common (73% vs 42%, p=0.001) and the extent of ischaemia was larger (4±3 vs 2±3 LV segments, p=0.005) in patients with higher aortic stiffness. In multivariable logistic regression analysis, higher aortic stiffness was associated with stress-induced myocardial ischaemia independent of other known covariables (OR 4.74 (95% CI 1.51 to 14.93), p=0.008).
In patients with stable angina and non-obstructive CAD, higher aortic stiffness was associated with stress-induced myocardial ischaemia. Consequently, assessment of aortic stiffness may add to the diagnostic evaluation in patients with non-obstructive CAD.
NCT01853527.
主动脉僵硬度增加可能会降低心肌灌注压，导致心肌缺血。在稳定性心绞痛和非阻塞性冠状动脉疾病（CAD）患者中，主动脉僵硬度是否与心肌缺血有关，目前研究较少。
在参加非阻塞性 CAD 项目的心肌缺血研究的 125 名稳定性心绞痛和非阻塞性 CAD 患者（62±8 岁，58%为女性）中，通过平板张力测定法评估主动脉僵硬度作为颈股脉搏波速度（PWV）。PWV 最高三分位数（>8.7m/s）被认为是较高的主动脉僵硬度。通过应激超声心动图检测应激诱导的心肌缺血，作为延迟心肌对比再充盈的左心室（LV）节段数作为缺血程度。
主动脉僵硬度较高的患者年龄较大，LV 质量指数较高，肥胖患病率较低（均 p<0.05），而心绞痛症状、性别、高血压、糖尿病、吸烟或 LV 射血分数在两组之间无差异。主动脉僵硬度较高的患者更常见应激诱导的心肌缺血（73%比 42%，p=0.001）和更大的缺血程度（4±3 个与 2±3 个 LV 节段，p=0.005）。多变量逻辑回归分析显示，在其他已知混杂因素的情况下，较高的主动脉僵硬度与应激诱导的心肌缺血相关（OR 4.74（95%CI 1.51 至 14.93），p=0.008）。
在稳定性心绞痛和非阻塞性 CAD 患者中，主动脉僵硬度较高与应激诱导的心肌缺血相关。因此，主动脉僵硬度的评估可能会增加对非阻塞性 CAD 患者的诊断评估。
NCT01853527。
Zotero 插件