Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
University of Florida, Gainesville, FL, USA.
Int J Cardiol. 2021 Jun 15;333:35-39. doi: 10.1016/j.ijcard.2021.02.064. Epub 2021 Mar 1.
Women with suspected ischemia and no obstructive coronary artery disease (INOCA) often have coronary microvascular dysfunction (CMD) as measured by impaired coronary flow reserve (CFR), which is associated with angina and adverse cardiovascular events. CFR is a ratio of hyperemic to baseline average peak velocity (bAPV), and the relation of baseline flow to angina is not understood.
We evaluated 259 women enrolled in the WISE-Coronary Vascular Dysfunction (WISE-CVD) project with suspected CMD who underwent invasive coronary functional testing. We analyzed variables stratified by high (e.g. ≥22 cm/s) vs low (<22 cm/s) bAPV, using t-test or Wilcoxon rank; linear and multivariable regression was used with bAPV as a continuous variable.
Women with high bAPV had worse Seattle Angina Questionnaire (SAQ) angina frequency (58 ± 26 vs 67 ± 25, p = 0.005) and SAQ-7 scores (57 ± 22 vs 62 ± 21, p = 0.03), with higher nitrate (p = 0.02) and ranolazine use (p = 0.03). The high bAPV subgroup also had lower CFR (p < 0.001)). Linear regression related higher bAPV with lower SAQ-7 (p = 0.01) and lower angina frequency scores (p = 0.001). These results remained significant in multivariable modelling adjusting for baseline differences (p < 0.04). SAQ-7 was significantly predicted by bAPV.
Among women with suspected INOCA, angina relates to high bAPV, a result supported by the concomitant greater use of anti-anginal drugs. These results suggest that high bAPV contributes to impaired CFR and may represent a specific pathophysiologic contributor to CMD and may be a treatment target in INOCA subjects.
怀疑患有缺血但无阻塞性冠状动脉疾病（INOCA）的女性通常存在冠状动脉微血管功能障碍（CMD），这可以通过受损的冠状动脉血流储备（CFR）来衡量，而后者与心绞痛和不良心血管事件相关。CFR 是充血时与基础平均峰值速度（bAPV）的比值，而基础流量与心绞痛之间的关系尚不清楚。
我们评估了 259 名患有疑似 CMD 的、参加 WISE-冠状动脉血管功能障碍（WISE-CVD）项目的女性，她们均接受了有创性冠状动脉功能检测。我们分析了 bAPV 高（例如≥22 cm/s）与低（<22 cm/s）分层的变量，使用 t 检验或 Wilcoxon 秩检验；使用 bAPV 作为连续变量进行线性和多变量回归。
bAPV 较高的女性西雅图心绞痛问卷（SAQ）心绞痛频率（58 ± 26 比 67 ± 25，p=0.005）和 SAQ-7 评分（57 ± 22 比 62 ± 21，p=0.03）更差，并且硝酸盐（p=0.02）和雷诺嗪使用率（p=0.03）更高。高 bAPV 亚组的 CFR 也较低（p<0.001）。线性回归显示，bAPV 越高，SAQ-7 评分越低（p=0.01），心绞痛频率评分越低（p=0.001）。在调整基线差异的多变量模型中，这些结果仍然具有统计学意义（p<0.04）。SAQ-7 评分可显著预测 bAPV。
在怀疑患有 INOCA 的女性中，心绞痛与高 bAPV 相关，这一结果得到了抗心绞痛药物使用频率更高的支持。这些结果表明，高 bAPV 导致 CFR 受损，可能是 CMD 的特定病理生理因素，并可能成为 INOCA 患者的治疗靶点。
