Barbra Streisand Women's Heart Center Cedars Sinai Smidt Heart Institute Los Angeles CA.
Emory Women's Heart Center Emory Clinical Cardiovascular Research Institute Atlanta GA.
J Am Heart Assoc. 2020 Jul 7;9(13):e016305. doi: 10.1161/JAHA.119.016305. Epub 2020 Jun 24.
Background Women with ischemia and no obstructive coronary artery disease are increasingly recognized and found to be at risk for major adverse cardiovascular events. Methods and Results In 214 women with suspected ischemia and no obstructive coronary artery disease who completed baseline and 1-year follow-up vasodilatory stress cardiac magnetic resonance imaging, we investigated temporal trends in angina (Seattle Angina Questionnaire [SAQ]), myocardial perfusion reserve index, blood pressure, and left ventricular (LV) remodeling and function from baseline to 1-year follow-up and explored associations between these different parameters. We observed concordant positive trends in 4/5 SAQ domains, SAQ-7, myocardial perfusion reserve index, blood pressure, LV mass, and LV mass-to-volume ratio. There was no association between SAQ-7 improvement and myocardial perfusion reserve index improvement over 1-year follow-up (=0.1). Higher indexed LV end-diastolic volume and time to peak filling rate at baseline were associated with increased odds of clinically relevant SAQ-7 improvement (odds ratio [OR], 1.05; 95% CI, 1.0-1.1; and OR, 2.40; 95% CI, 1.1-5.0, respectively). Hypertension was associated with decreased odds of SAQ-7 improvement (OR, 0.41; 95% CI, 0.19-0.91). Conclusions In women with ischemia and no obstructive coronary artery disease clinically treated with cardiac medications over 1 year, we observed concurrent temporal trends toward improvement in SAQ, myocardial perfusion reserve index, blood pressure, LV mass, and LV mass-to volume ratio. We showed that abnormalities in LV morphology and diastolic function at baseline were predictive of clinically significant improvement in angina at follow-up, whereas history of hypertension was associated with lower odds. Future studies are needed to assess the mechanisms and treatments responsible for the improvements we observed. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02582021.
越来越多患有缺血但无阻塞性冠状动脉疾病的女性被识别出来，并且发现她们存在发生主要不良心血管事件的风险。
在 214 名疑似缺血且无阻塞性冠状动脉疾病的女性中，她们完成了基线和 1 年随访的扩张性应激心脏磁共振成像检查，我们调查了从基线到 1 年随访期间心绞痛（西雅图心绞痛问卷 [SAQ]）、心肌灌注储备指数、血压和左心室（LV）重构和功能的时间趋势，并探讨了这些不同参数之间的相关性。我们观察到 4/5 的 SAQ 域、SAQ-7、心肌灌注储备指数、血压、LV 质量和 LV 质量与容积比均呈阳性趋势。在 1 年随访期间，SAQ-7 改善与心肌灌注储备指数改善之间没有关联（相关系数=0.1）。较高的基线左室舒张末期容积指数和峰值充盈率时间与增加 SAQ-7 临床相关改善的可能性相关（优势比 [OR]，1.05；95%CI，1.0-1.1；OR，2.40；95%CI，1.1-5.0）。高血压与 SAQ-7 改善的可能性降低相关（OR，0.41；95%CI，0.19-0.91）。
在接受心脏药物治疗 1 年以上的缺血且无阻塞性冠状动脉疾病的女性中，我们观察到 SAQ、心肌灌注储备指数、血压、LV 质量和 LV 质量与容积比同时呈改善趋势。我们发现，基线时 LV 形态和舒张功能异常与随访时心绞痛的显著改善相关，而高血压病史与改善的可能性降低相关。需要进一步的研究来评估我们观察到的改善的机制和治疗方法。
https://www.clinicaltrials.gov；独特标识符：NCT02582021。
