Östlund-Papadogeorgos Nikolaos, Ekenbäck Christina, Jokhaji Fadi, Mir-Akbari Habib, Witt Nils, Jernberg Tomas, Wallén Håkan, Linder Rikard, Törnerud Mattias, Samad Bassem A, Persson Jonas
Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.
Karolinska Institutet, Department of Clinical Science and Education, Division of Cardiology, Södersjukhuset, Stockholm, Sweden.
Int J Cardiol. 2020 Oct 15;317:1-6. doi: 10.1016/j.ijcard.2020.05.037. Epub 2020 May 25.
Coronary microvascular dysfunction (CMVD) is associated with adverse cardiovascular outcome. We aimed to determine the prevalence of CMVD and factors related to index of microcirculatory resistance (IMR) in consecutive patients with chronic coronary syndrome (CCS) undergoing elective coronary angiography.
Non-interventional physicians enrolled 274 patients with CCS before angiography, to minimize selection bias by PCI-operators. Fractional flow reserve (FFR) and IMR were measured in the LAD. Subjects with extensively diseased LAD, no measures due to technical reasons or violation of protocol were excluded from the analysis (n = 54). The proportion of patients with IMR corrected for collateral flow (IMR) >25 units was 25% (95% confidence interval [CI] 19%-31%) in all 220 patients. In subjects with FFR ≤0.80 in the LAD the proportion of IMR > 25 units was 21% (95% CI 13%-30%) as compared to subjects with FFR >0.80, 29% (95% CI 21%-36%), p = .268. Haemoglobin (p < .005; r2 = 0.084), FFR in the LAD (p = .001; r2 = 0.049), creatinine clearance (p = .001; r = 0.049; inversely), and NT-proBNP (p = .038; r = 0.021) were independently associated with IMR in multivariate linear regression analysis.
We report that IMR is associated with renal dysfunction, NT-proBNP, FFR in the LAD and, for the first time, blood haemoglobin. One in four of patients referred for coronary angiography due to CCS have CMVD defined as IMR > 25 in the LAD.
冠状动脉微血管功能障碍（CMVD）与不良心血管结局相关。我们旨在确定接受择期冠状动脉造影的连续性慢性冠状动脉综合征（CCS）患者中CMVD的患病率以及与微循环阻力指数（IMR）相关的因素。
非介入科医生在血管造影术前纳入了274例CCS患者，以尽量减少PCI操作者的选择偏倚。在左前降支（LAD）测量血流储备分数（FFR）和IMR。因LAD广泛病变、技术原因未进行测量或违反方案的受试者被排除在分析之外（n = 54）。在所有220例患者中，校正侧支血流后的IMR（IMR）>25单位的患者比例为25%（95%置信区间[CI] 19%-31%）。与LAD中FFR>0.80的受试者相比，LAD中FFR≤0.80的受试者中IMR>25单位的比例为21%（95% CI 13%-30%），FFR>0.80的受试者中该比例为29%（95% CI 21%-36%），p = 0.268。在多变量线性回归分析中，血红蛋白（p < 0.005；r2 = 0.084）、LAD中的FFR（p = 0.001；r2 = 0.049）、肌酐清除率（p = 0.001；r = 0.049；呈负相关）和NT-proBNP（p = 0.038；r = 0.021）与IMR独立相关。
我们报告IMR与肾功能不全、NT-proBNP、LAD中的FFR以及首次发现的血红蛋白相关。因CCS接受冠状动脉造影的患者中有四分之一患有CMVD，定义为LAD中IMR>25。
