Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium.
Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium; Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy.
Int J Cardiol. 2021 Jun 15;333:8-13. doi: 10.1016/j.ijcard.2021.02.085. Epub 2021 Mar 3.
Coronary microvascular dysfunction is a powerful prognostic factor in patients with coronary artery disease. We investigated the role of reactive digital hyperemia peripheral arterial tonometry (RH-PAT) as a non-invasive tool to identify patients with impaired coronary microvasculature.
Patients undergoing elective coronary angiography were consecutively assessed for peripheral microvascular endothelial function before coronary angiography: both the Reactive Hyperemic Index (RHI) and the Framingham reactive hyperemic index (Endoscore) were measured. During coronary angiography, the Index of microvascular resistance (IMR) was measured in all patients, and an IMR value > 25 identified patients with coronary microvascular impairment.
A total of 47 patients with chronic coronary syndromes candidate to coronary angiography were included. Those with coronary microvascular impairment (n = 18 [38%]) presented with significantly lower RHI (1.68 ± 0.38 vs. 1.94 ± 0.93, p = 0.04) and Endoscore 0.50 ± 0.23 vs. 0.64 ± 0.23, p = 0.04) values as compared with patients with preserved coronary microvasculature. A significant relationship was observed between IMR with both RHI (r = 0.35, p = 0.02) and Endoscore (r = 0.34, p = 0.02). At the multivariable analysis, RHI and Endoscore were the only independent predictors of an IMR > 25.
Our study demonstrates that digital reactive hyperemia indexes are lower in patients with high IMR values, suggesting a role for RH-PAT as non-invasive tool for identifying patients with coronary microvascular impairment.
冠状动脉微血管功能障碍是冠状动脉疾病患者强有力的预后因素。我们研究了反应性指端动脉张力测定（RH-PAT）作为一种识别冠状动脉微血管功能障碍患者的非侵入性工具的作用。
连续评估接受选择性冠状动脉造影的患者的外周微血管内皮功能：测量反应性充血指数（RHI）和弗雷明汉反应性充血指数（Endoscore）。在所有患者中进行冠状动脉造影时测量微血管阻力指数（IMR），IMR 值>25 识别出有冠状动脉微血管功能障碍的患者。
共纳入 47 例有慢性冠状动脉综合征行冠状动脉造影的患者。有冠状动脉微血管功能障碍的患者（n=18 [38%]）的 RHI（1.68±0.38 比 1.94±0.93，p=0.04）和 Endoscore（0.50±0.23 比 0.64±0.23，p=0.04）明显较低。IMR 与 RHI（r=0.35，p=0.02）和 Endoscore（r=0.34，p=0.02）呈显著相关性。多变量分析显示，RHI 和 Endoscore 是 IMR>25 的唯一独立预测因子。
我们的研究表明，高 IMR 值患者的指端反应性充血指数较低，提示 RH-PAT 作为一种识别冠状动脉微血管功能障碍患者的非侵入性工具具有一定作用。
