Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
JACC Cardiovasc Interv. 2021 Mar 22;14(6):606-618. doi: 10.1016/j.jcin.2020.12.025.
Whether there are prognostic links between coronary morphologies and coronary functional abnormalities was examined in ischemia and nonobstructive coronary artery disease (INOCA) patients.
Although INOCA has attracted much attention, little is known about the prognostic impact of coronary morphologies in this disorder.
A total of 329 consecutive INOCA patients were enrolled and underwent spasm provocation testing combined with lactate sampling for diagnosis of epicardial and microvascular spasm (MVS). On the basis of the functional tests, the patients were classified into 4 groups: a control group without epicardial spasm or MVS (n = 32), MVS alone (n = 51), diffuse spasm in ≥2 coronary segments (n = 204), and focal spasm in 1 segment (n = 42). In this population, optical coherence tomography imaging of the left anterior descending coronary artery was performed for evaluation of adventitial vasa vasorum (AVV) and intraplaque neovessels (IPN). Index of microcirculatory resistance was also measured.
MVS frequently coexisted with diffuse (70%) and focal spasm (68%) with a good correlation between AVV and index of microcirculatory resistance (R = 0.353; p = 0.022). For a median follow-up of 1,043 days, focal spasm showed the worst prognosis (log rank p = 0.005), for which IPN was a significant prognostic factor. By contrast, diffuse spasm showed the greatest AVV with an intermediate prognosis. The prognostic value of INOCA was significantly enhanced by adding AVV and IPN to the physiological indices (area under the curve = 0.88 vs. 0.76; p = 0.048).
These results provide the first evidence that there are important prognostic links between coronary morphologies (evaluated by optical coherence tomography) and coronary functional abnormalities in patients with INOCA, indicating the importance of both evaluations in this population.
探讨缺血性非阻塞性冠状动脉疾病（INOCA）患者冠状动脉形态与冠状动脉功能异常之间是否存在预后相关性。
尽管 INOCA 已引起广泛关注，但对于该疾病中冠状动脉形态的预后影响知之甚少。
共纳入 329 例连续 INOCA 患者，行痉挛激发试验联合乳酸性盐采样以诊断心外膜和微血管痉挛（MVS）。基于功能检查，将患者分为 4 组：无心外膜痉挛或 MVS 的对照组（n=32）、单纯 MVS 组（n=51）、≥2 个冠状动脉节段弥漫性痉挛组（n=204）和 1 个节段局限性痉挛组（n=42）。在此人群中，对左前降支进行光学相干断层扫描成像，以评估外膜血管丛（AVV）和斑块内新生血管（IPN）。还测量了微血管阻力指数。
MVS 常与弥漫性痉挛（70%）和局限性痉挛（68%）共存，AVV 与微血管阻力指数之间存在良好相关性（R=0.353；p=0.022）。中位随访 1043 天期间，局限性痉挛预后最差（对数秩检验，p=0.005），IPN 是显著的预后因素。相比之下，弥漫性痉挛的 AVV 最大，预后中等。通过将 AVV 和 IPN 加入生理指标，INOCA 的预后价值显著增强（曲线下面积从 0.76 增加至 0.88；p=0.048）。
这些结果首次提供证据表明，在 INOCA 患者中，冠状动脉形态（通过光学相干断层扫描评估）与冠状动脉功能异常之间存在重要的预后相关性，表明在该人群中这两种评估都很重要。
