Ozcan Cevher, Allan Tess, Besser Stephanie A, de la Pena Anthony, Blair John
Department of Medicine, University of Chicago 5841 S. Maryland Avenue, MC 6080, Chicago, IL 60637, USA.
Section of Cardiology, Department of Medicine, University of Chicago 5841 S. Maryland Avenue, MC 6080, Chicago, IL 60637, USA.
Am J Cardiovasc Dis. 2021 Feb 15;11(1):29-38. eCollection 2021.
Coronary microvascular dysfunction (CMD) is a new frontier in cardiovascular disease and an important contributor to myocardial ischemia. A high prevalence of CMD is shown in heart failure, however, the cause-and-effect relationship between CMD and atrial fibrillation (AF) is unknown. We hypothesize that CMD is associated with AF and increases susceptibility to the co-existence of AF and heart failure with preserved ejection fraction (HFpEF).
Our study examined the relationship between CMD, AF, and HFpEF in all patients who underwent invasive coronary physiology studies for assessment of chest pain or dyspnea. CMD was defined as impaired coronary flow reserve (CFR) without obstructive coronary disease.
A total of 80 patients (mean age 60±12 years, 68.8% female, median follow up of 2.2 years) were studied. Patients with AF (61%) or HFpEF (62%), or both (71%) were more likely to have CMD than those patients without these conditions. Of the patients with AF and abnormal CFR, 91% had HFpEF. CMD was a predictor of AF with concomitant HFpEF (OR 4.38, P=0.02). Our clinical outcome analysis demonstrated that patients with CMD, AF or HFpEF had lower survival free of HF hospitalization than those patients without (P<0.05). AF (OR 5.5, P=0.02), diabetes, older age, female gender, and higher heart rate were predictors of CMD.
CMD is highly prevalent in patients with AF with or without HFpEF. CMD is associated with poor clinical outcomes and the co-existence of AF and HFpEF. Understanding of the association between CMD and AF is important for developing an effective treatment strategy and the risk stratification for the prevention of AF in patients with CMD and vice versa.
冠状动脉微血管功能障碍（CMD）是心血管疾病的一个新领域，也是心肌缺血的一个重要因素。心力衰竭患者中CMD的患病率较高，然而，CMD与心房颤动（AF）之间的因果关系尚不清楚。我们假设CMD与AF相关，并增加了AF与射血分数保留的心力衰竭（HFpEF）共存的易感性。
我们的研究在所有因胸痛或呼吸困难接受有创冠状动脉生理学研究的患者中，考察了CMD、AF和HFpEF之间的关系。CMD被定义为无阻塞性冠状动脉疾病的冠状动脉血流储备（CFR）受损。
共研究了80例患者（平均年龄60±12岁，68.8%为女性，中位随访2.2年）。与没有这些情况的患者相比，患有AF（61%）或HFpEF（62%）或两者都有的患者（71%）更有可能患有CMD。在AF和CFR异常的患者中，91%患有HFpEF。CMD是AF合并HFpEF的一个预测指标（比值比4.38，P=0.02）。我们的临床结局分析表明，患有CMD、AF或HFpEF的患者无HF住院的生存率低于没有这些疾病的患者（P<0.05）。AF（比值比5.5，P=0.02）、糖尿病、老年、女性性别和较高的心率是CMD的预测指标。
CMD在伴有或不伴有HFpEF的AF患者中非常普遍。CMD与不良临床结局以及AF和HFpEF的共存相关。了解CMD与AF之间的关联对于制定有效的治疗策略以及对CMD患者预防AF的风险分层很重要，反之亦然。
