Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
JACC Cardiovasc Imaging. 2021 Nov;14(11):2212-2220. doi: 10.1016/j.jcmg.2020.12.031. Epub 2021 Mar 17.
The purpose of this study was to evaluate the prognostic value of quantitative myocardial blood flow (MBF) and myocardial flow reserve (MFR), reflecting the integrated effects of diffuse atherosclerosis and microvascular dysfunction in patients with systemic inflammatory disorders.
Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and psoriasis (PsO) are common inflammatory conditions with excess cardiovascular (CV) risk compared to the general population. Systemic inflammation perturbs endothelial function and has been linked to coronary vasomotor dysfunction. However, the prognostic significance of this vascular dysfunction is not known.
This was a retrospective study of patients with RA, SLE, and PsO undergoing clinically indicated rest and stress myocardial perfusion positron emission tomography (PET). Patients with an abnormal myocardial perfusion study or left ventricular dysfunction were excluded. MFR was calculated as the ratio of myocardial blood flow (MBF, ml/min/g) at peak stress compared to that at rest.
Among the 198 patients (median age: 65 years; 80% female), 20.7% had SLE, 31.8% had PsO, and 47.5% had RA. There were no differences in mean MFR between these conditions. Over a median follow-up of 7.8 years, there were 51 deaths and 63 major adverse cardiovascular events (MACE). Patients in the lowest tertile (MFR <1.65) had higher all-cause mortality than the highest tertile, which remained significant after adjusting for age, sex, and the pre-test clinical risk score (hazard ratio [HR]: 2.4; 95% confidence interval [CI]: 1.05 to 5.4; p = 0.038). Similarly, compared to the highest MFR tertile, those in the lowest tertile had a lower MACE-free survival after adjusting for age, sex, and the pre-test clinical risk score (HR: 3.6; 95% CI: 1.7 to 7.6; p = 0.001).
In patients with systemic inflammatory disorders, impaired coronary vasodilator reserve was associated with worse cardiovascular outcomes and all-cause mortality.
本研究旨在评估定量心肌血流（MBF）和心肌血流储备（MFR）的预后价值，这反映了弥漫性动脉粥样硬化和微血管功能障碍对系统性炎症性疾病患者的综合影响。
类风湿关节炎（RA）、系统性红斑狼疮（SLE）和银屑病（PsO）是常见的炎症性疾病，与普通人群相比，心血管（CV）风险增加。系统性炎症会扰乱内皮功能，并与冠状动脉血管舒缩功能障碍有关。然而，这种血管功能障碍的预后意义尚不清楚。
这是一项回顾性研究，纳入了接受临床指征性静息和应激心肌灌注正电子发射断层扫描（PET）的 RA、SLE 和 PsO 患者。排除了存在异常心肌灌注研究或左心室功能障碍的患者。MFR 计算为峰值应激时心肌血流（MBF，ml/min/g）与静息时的比值。
在 198 例患者中（中位年龄：65 岁；80%为女性），20.7%患有 SLE，31.8%患有 PsO，47.5%患有 RA。这些疾病的平均 MFR 之间没有差异。在中位随访 7.8 年后，有 51 例死亡和 63 例主要不良心血管事件（MACE）。MFR<1.65 的最低三分位组患者全因死亡率高于最高三分位组，调整年龄、性别和预试验临床风险评分后仍有显著差异（风险比[HR]：2.4；95%置信区间[CI]：1.05 至 5.4；p=0.038）。同样，与最高 MFR 三分位组相比，调整年龄、性别和预试验临床风险评分后，最低三分位组的 MACE 无事件生存率较低（HR：3.6；95%CI：1.7 至 7.6；p=0.001）。
在系统性炎症性疾病患者中，冠状动脉舒张储备受损与心血管结局和全因死亡率较差相关。
