Department of Cardiology, Hvidovre University Hospital, University of Copenhagen, Kettegaard Allé 30, 2650 Hvidovre, Copenhagen, Denmark.
Department of Cardiology, Hvidovre University Hospital, University of Copenhagen, Kettegaard Allé 30, 2650 Hvidovre, Copenhagen, Denmark; Center for Functional and Diagnostic Imaging and Research, Hvidovre University Hospital, University of Copenhagen, Kettegaard Alle 30, 2650 Hvidovre, Copenhagen, Denmark.
Int J Cardiol. 2019 Oct 15;293:1-9. doi: 10.1016/j.ijcard.2019.07.048. Epub 2019 Jul 17.
Both coronary microvascular dysfunction (CMD) and reduced exercise capacity are associated with adverse cardiovascular prognosis. The association between CMD and cardiopulmonary exercise testing (CPET) derived exercise capacity in symptomatic individuals without obstructive coronary artery disease (CAD) is not clear. We investigated whether exercise capacity was reduced in women with angina, CMD and no obstructive CAD compared with sex-matched controls. Furthermore, we assessed the association between CMD and other CPET-derived variables.
All participants underwent transthoracic Doppler echocardiography of the left anterior descending artery with dipyridamole-induced vasodilation and CPET using ergometer cycle with an incremental test protocol.
We included 99 women with angina and no obstructive CAD (patients) and 27 asymptomatic women (controls), age (mean ± standard deviation) 61 ± 10 and 58 ± 10 years, respectively. Patients had a higher burden of risk factors compared with controls, while the weekly physical activity level was comparable between the groups (p = 0.72). CMD was present in 27 (27%) patients and 5 (19%) controls. Peak VO was significantly reduced in patients with CMD compared with controls with normal coronary microvascular function ((median (IQR) 17.3 (15.5-21.3) vs. 27.3 (21.6-30.8) ml/kg/min; age-adjusted p = 0.001), independent of cardiovascular risk factors (p = 0.041). Presence of CMD in symptomatic women was also associated with diminished heart rate reserve (p < 0.001) and blunted heart rate recovery.
Women with angina, CMD and no obstructive CAD have markedly reduced exercise capacity compared with sex-matched controls. Moreover, combination of angina and CMD is associated with impaired heart rate response and heart rate recovery.
冠状动脉微血管功能障碍（CMD）和运动能力下降均与不良心血管预后相关。在无阻塞性冠状动脉疾病（CAD）的有症状个体中，CMD 与心肺运动试验（CPET）得出的运动能力之间的关系尚不清楚。我们研究了与性别匹配的对照组相比，患有心绞痛、CMD 和无阻塞性 CAD 的女性的运动能力是否降低。此外，我们评估了 CMD 与其他 CPET 衍生变量之间的关系。
所有参与者均接受经胸多普勒超声心动图检查左前降支，并用二吡啶酰胺诱导血管扩张，并使用测力计进行 CPET，采用递增测试方案。
我们纳入了 99 名患有心绞痛且无阻塞性 CAD 的女性患者（患者）和 27 名无症状女性（对照组），年龄（平均值±标准差）分别为 61±10 和 58±10 岁。与对照组相比，患者的危险因素负担更高，而两组的每周体力活动水平相当（p=0.72）。27 名患者（27%）和 5 名对照者（19%）存在 CMD。与冠状动脉微血管功能正常的对照组相比，CMD 患者的峰值 VO 显著降低（（中位数（IQR）17.3（15.5-21.3）vs. 27.3（21.6-30.8）ml/kg/min；年龄校正后 p=0.001），独立于心血管危险因素（p=0.041）。在有症状的女性中，CMD 的存在也与心率储备减少（p<0.001）和心率恢复减弱有关。
与性别匹配的对照组相比，患有心绞痛、CMD 和无阻塞性 CAD 的女性运动能力明显降低。此外，心绞痛和 CMD 的组合与心率反应和心率恢复受损有关。
