INOCA 的功能和经济影响及冠状动脉微血管功能障碍的影响。
Functional and Economic Impact of INOCA and Influence of Coronary Microvascular Dysfunction.
机构信息
Division of Cardiovascular Medicine and the Cardiac Imaging Center, University of Virginia Health System, Charlottesville, Virginia, USA.
Division of Cardiovascular Medicine and the Cardiac Imaging Center, University of Virginia Health System, Charlottesville, Virginia, USA; Biomedical Engineering and Imaging Institute and Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
出版信息
JACC Cardiovasc Imaging. 2021 Jul;14(7):1369-1379. doi: 10.1016/j.jcmg.2021.01.041. Epub 2021 Apr 14.
OBJECTIVES
This study sought to better characterize the quality of life and economic impact in patients with symptoms of ischemia and no obstructive coronary disease (INOCA) and to identify the influence of coronary microvascular dysfunction (CMD).
BACKGROUND
Patients with INOCA have a high symptom burden and an increased incidence of major adverse cardiac events. CMD is a frequent cause of INOCA. The morbidity associated with INOCA and CMD has not been well-characterized.
METHODS
Sixty-six patients with INOCA underwent stress cardiac magnetic resonance with calculation of myocardial perfusion reserve (MPR); MPR 2.0 to 2.4 was considered borderline-reduced (possible CMD) and MPR <2.0 was defined as reduced (definite CMD). Subjects completed quality of life questionnaires to assess the morbidity and economic impact of INOCA. Questionnaire results were compared between INOCA patients with and without CMD. In addition, logistic regression was used to determine the predictors of CMD within the INOCA population.
RESULTS
The prevalence of definite CMD was 24%. Definite or borderline CMD was present in 59% (MPR ≤2.4). Patients with INOCA reported greater physical limitation, angina frequency, and reduced quality of life compared to referent stable coronary artery disease and acute myocardial infarction populations. In addition, Patients with INOCA reported frequent time missed from work and work limitations, suggesting a substantial economic impact. No difference was observed in reported symptoms between INOCA patients with and without CMD. Glomerular filtration rate and body-mass index were significant predictors of CMD in multivariable regression analysis.
CONCLUSIONS
INOCA is associated with high morbidity similar to other high-risk cardiac populations, and work limitations reported by Patients with INOCA suggest a substantial economic impact. CMD is a common cause of INOCA but is not associated with increased morbidity. These results suggest that there is significant symptom burden in the INOCA population regardless of etiology.
目的
本研究旨在更好地描述有缺血症状但无阻塞性冠状动脉疾病（INOCA）患者的生活质量和经济影响，并确定冠状动脉微血管功能障碍（CMD）的影响。
背景
有 INOCA 的患者症状负担重，且发生重大不良心脏事件的几率增加。CMD 是 INOCA 的常见病因。INOCA 和 CMD 相关的发病率尚未得到充分描述。
方法
66 例有 INOCA 的患者接受了心脏磁共振负荷试验，计算心肌灌注储备（MPR）；MPR 在 2.0 至 2.4 之间被认为是临界降低（可能存在 CMD），MPR<2.0 被定义为降低（明确存在 CMD）。患者完成了生活质量问卷，以评估 INOCA 的发病率和经济影响。比较了有和无 CMD 的 INOCA 患者的问卷结果。此外，还使用逻辑回归确定了 INOCA 人群中 CMD 的预测因素。
结果
明确 CMD 的患病率为 24%。明确或临界 CMD 见于 59%（MPR≤2.4）的患者。与参照的稳定型冠状动脉疾病和急性心肌梗死人群相比，有 INOCA 的患者报告了更大的身体受限、心绞痛发作频率和降低的生活质量。此外，有 INOCA 的患者报告经常缺勤和工作受限，表明经济影响较大。在有和无 CMD 的 INOCA 患者之间，报告的症状没有差异。肾小球滤过率和体重指数是多变量回归分析中 CMD 的显著预测因素。
结论
INOCA 与其他高危心脏人群一样，发病率高，且有 INOCA 的患者报告的工作受限表明经济影响较大。CMD 是 INOCA 的常见病因，但与发病率增加无关。这些结果表明，无论病因如何，INOCA 人群都存在明显的症状负担。
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