Department of Cardiology, Hvidovre University Hospital, University of Copenhagen, Kettegaard Allé 30, Hvidovre, 2650, Copenhagen, Denmark.
Department of Cardiology, Bispebjerg University Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark.
Int J Cardiovasc Imaging. 2020 Feb;36(2):367-382. doi: 10.1007/s10554-019-01723-5. Epub 2019 Nov 1.
Women with angina and no obstructive coronary artery disease (CAD) have worse cardiovascular prognosis than asymptomatic women. Limitation in myocardial perfusion caused by coronary microvascular dysfunction (CMD) is one of the proposed mechanisms contributing to the adverse prognosis. The aim of this study was to assess myocardial perfusion in symptomatic women with no obstructive CAD suspected for CMD compared with asymptomatic sex-matched controls using static CT perfusion (CTP). We performed a semi-quantitative assessment of the left ventricular myocardial perfusion and myocardial perfusion reserve (MPR), using static CTP with adenosine provocation, in 105 female patients with angina and no obstructive CAD (< 50% stenosis) and 33 sex-matched controls without a history of angina or ischemic heart disease. Patients were on average 4 years older (p = 0.04) and had a higher burden of cardiovascular risk factors. While global perfusion during rest was comparable between the groups (age-adjusted p = 0.12), global perfusion during hyperemia was significantly reduced in patients compared with controls (163 ± 23 HU vs. 171 ± 25 HU; age-adjusted p = 0.023). The ability to increase myocardial perfusion during adenosine-induced vasodilation was significantly diminished in patients (MPR 148% vs. 158%; age-adjusted p < 0.001). This remained unchanged after adjustment for cardiovascular risk factors (p = 0.008). Women with angina and no obstructive CAD have reduced hyperemic myocardial perfusion and MPR compared with sex-matched controls. Impaired myocardial perfusion may be related to the presence of CMD in some of these women.
患有稳定型心绞痛且无阻塞性冠状动脉疾病 (CAD) 的女性心血管预后比无症状女性更差。由冠状动脉微血管功能障碍 (CMD) 引起的心肌灌注受限是导致不良预后的机制之一。本研究旨在通过腺苷激发静态 CT 灌注 (CTP) 评估怀疑患有 CMD 的有症状且无阻塞性 CAD 的女性与无症状配对性别对照者的心肌灌注。我们对 105 名有稳定型心绞痛且无阻塞性 CAD（<50%狭窄）的女性患者和 33 名无心绞痛或缺血性心脏病史的配对性别对照者使用腺苷激发的静态 CTP 进行了左心室心肌灌注和心肌灌注储备 (MPR) 的半定量评估。患者的平均年龄大 4 岁（p=0.04），且心血管危险因素负担较高。虽然两组的静息时整体灌注相似（年龄调整后 p=0.12），但患者的充血时整体灌注明显低于对照组（163±23 HU 比 171±25 HU；年龄调整后 p=0.023）。与对照组相比，患者在腺苷诱导的血管扩张期间增加心肌灌注的能力明显降低（MPR 为 148%比 158%；年龄调整后 p<0.001）。调整心血管危险因素后仍未改变（p=0.008）。患有稳定型心绞痛且无阻塞性 CAD 的女性与配对性别对照组相比，充血时心肌灌注和 MPR 减少。心肌灌注受损可能与这些女性中存在 CMD 有关。
