超声心动图相关指标评估肥厚型心肌病患者微血管阻力的侵袭性方法。

Invasive Assessment of Microvascular Resistance in Hypertrophic Cardiomyopathy With Echocardiographic Correlates.

机构信息

Division of Cardiology, Department of Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada.

出版信息

Heart Lung Circ. 2022 Feb;31(2):194-198. doi: 10.1016/j.hlc.2021.07.002. Epub 2021 Jul 28.

DOI:10.1016/j.hlc.2021.07.002

PMID:34332889

Abstract

INTRODUCTION

Hypertrophic cardiomyopathy (HCM) is often associated with ischaemia despite lack of focal epicardial coronary stenosis. Our aim was to assess invasive coronary microvascular circulation and correlate findings with echocardiography.

METHODS

We prospectively enrolled patients with HCM and controls who were referred for diagnostic coronary angiography. A pressure-temperature sensor coronary guidewire was used with intracoronary injections of room-temperature saline to measure mean coronary transit time during rest and hyperaemia induced with intravenous adenosine. The index of microvascular resistance (IMR) was calculated. Left ventricular mass was calculated during echocardiographic studies.

RESULTS

Patients with HCM (n=12) and controls (n=7), had similar demographics. Left ventricular ejection fraction was higher in HCM (76.7%±11.0% vs 55.0%±15.9%, p=0.003). IMR was non-significantly higher in HCM (21.7±10.2 vs 15.3±4.8, p=0.16). Only patients with HCM had abnormal IMR (>25). Coronary flow reserve was non-significantly higher in HCM (2.7±1.6 vs 2.1±1.2, p=0.34). IMR correlated with left ventricular mass in hypertrophic cardiomyopathy subjects (Pearson r=0.68, p=0.02).

CONCLUSIONS

Microvascular dysfunction as assessed by IMR may be abnormal in HCM and is correlated with left ventricular mass.

摘要

简介

尽管没有局灶性心外膜冠状动脉狭窄，但肥厚型心肌病（HCM）通常与缺血有关。我们的目的是评估有创性冠状动脉微血管循环，并将发现与超声心动图相关联。

方法

我们前瞻性地招募了因诊断性冠状动脉造影而转介的 HCM 患者和对照组患者。使用压力-温度传感器冠状动脉导丝，通过冠状动脉内注射室温生理盐水，在静息和静脉注射腺苷诱导的充血期间测量平均冠状动脉通过时间。计算微血管阻力指数（IMR）。在超声心动图研究期间计算左心室质量。

结果

HCM 患者（n=12）和对照组（n=7）的人口统计学特征相似。HCM 患者的左心室射血分数较高（76.7%±11.0% vs 55.0%±15.9%，p=0.003）。HCM 患者的 IMR 升高不显著（21.7±10.2 vs 15.3±4.8，p=0.16）。只有 HCM 患者的 IMR 异常（>25）。HCM 患者的冠状动脉血流储备升高不显著（2.7±1.6 vs 2.1±1.2，p=0.34）。IMR 与肥厚型心肌病患者的左心室质量相关（Pearson r=0.68，p=0.02）。