Muroya Takahiro, Kawano Hiroaki, Koga Seiji, Ikeda Satoshi, Yamamoto Fumi, Maemura Koji
Circulatory Division, Sasebo City General Hospital, Japan.
Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan.
Intern Med. 2020;59(23):2981-2987. doi: 10.2169/internalmedicine.5401-20. Epub 2020 Dec 1.
Objective Associations between aortic stiffness and cardiovascular disease events are mediated in part by pathways that include coronary microvascular dysfunction (CMD) and remodeling. However, the relationship between aortic stiffness and CMD remains unclear. The present study aimed to determine whether aortic stiffness causes CMD as evaluated by the hyperemic microvascular resistance index (hMVRI) in patients with non-obstructive coronary artery disease (CAD). Methods The intracoronary physiological variables in 209 coronary arteries were evaluated in 121 patients with non-obstructive CAD (fractional flow reserve >0.80) or reference vessels. The cardio-ankle vascular index (CAVI) as a measure of aortic stiffness and atherosclerotic risk factors were also measured. Results Univariate analyses showed that hMVRI correlated with age (β=0.24, p=0.007), eicosapentaenoic acid (EPA; β=-0.18, p=0.048), EPA/arachidonic acid (AA) (EPA/AA) ratio (β=-0.22, p=0.014) and CAVI (β=0.30, p=0.001). A multivariate regression analysis identified CAVI (β=0.25, p=0.007) and EPA/AA ratio (β=-0.26, SE=0.211, p=0.003) as independent determinants of hMVRI. Conclusion Aortic stiffness may cause CMD in patients with non-obstructive CAD via increased coronary microvascular resistance. Aortic stiffness is associated with CMD which is evaluated as hyperemic microvascular resistance in patients with non-obstructive CAD.
目的 主动脉僵硬度与心血管疾病事件之间的关联部分是由包括冠状动脉微血管功能障碍（CMD）和重塑在内的途径介导的。然而，主动脉僵硬度与CMD之间的关系仍不清楚。本研究旨在确定在非阻塞性冠状动脉疾病（CAD）患者中，主动脉僵硬度是否会导致通过充血微血管阻力指数（hMVRI）评估的CMD。方法 对121例非阻塞性CAD（血流储备分数>0.80）患者或对照血管的209条冠状动脉的冠状动脉内生理变量进行评估。还测量了作为主动脉僵硬度指标的心脏-脚踝血管指数（CAVI）和动脉粥样硬化危险因素。结果 单因素分析显示，hMVRI与年龄（β=0.24，p=0.007）、二十碳五烯酸（EPA；β=-0.18，p=0.048）、EPA/花生四烯酸（AA）（EPA/AA）比值（β=-0.22，p=0.014）和CAVI（β=0.30，p=0.001）相关。多因素回归分析确定CAVI（β=0.25，p=0.007）和EPA/AA比值（β=-0.26，SE=0.211，p=0.003）是hMVRI的独立决定因素。结论 在非阻塞性CAD患者中，主动脉僵硬度可能通过增加冠状动脉微血管阻力导致CMD。主动脉僵硬度与CMD相关，CMD在非阻塞性CAD患者中通过充血微血管阻力进行评估。
