冠状动脉内皮功能障碍似乎是全身过程的一种表现：来自女性缺血综合征评估-冠状动脉血管功能障碍（WISE-CVD）研究的报告。
Coronary endothelial dysfunction appears to be a manifestation of a systemic process: A report from the Women's Ischemia Syndrome Evaluation - Coronary Vascular Dysfunction (WISE-CVD) study.
机构信息
Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
Emory Clinical Cardiovascular Research Institute (ECCRI), Emory University School of Medicine, Atlanta, GA, United States of America.
出版信息
PLoS One. 2021 Sep 27;16(9):e0257184. doi: 10.1371/journal.pone.0257184. eCollection 2021.
BACKGROUND
Coronary microvascular dysfunction (CMD) is prevalent in symptomatic women with ischemia but no obstructive coronary artery disease (INOCA). Urine albumin-creatinine ratio (UACR) is a measure of renal microvascular endothelial dysfunction. Both are predictors of adverse cardiovascular events. It is unknown if CMD could be a manifestation of a systemic process. We evaluated the relationship between renal microvascular dysfunction and CMD as measured by invasive coronary function testing (CFT).
METHODS AND RESULTS
We measured urine albumin and creatinine to provide UACR in 152 women enrolled in the Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study (2008-2015) with suspected INOCA who underwent CFT. Invasive CFT measures of endothelial and non-endothelial dependent coronary microvascular function were obtained. Subjects were divided into those with detectable (≥20 mg/g) and undetectable urine albumin (<20 mg/g). The group mean age was 54 ± 11 years, with a moderate cardiac risk factor burden including low diabetes prevalence, and a mean UACR of 12 ± 55 mg/g (range 9.5-322.7 mg/g). Overall, coronary endothelial-dependent variables (change in coronary blood flow and coronary diameter in response to cold pressor testing) had significant inverse correlations with log UACR (r = -0.17, p = 0.05; r = -0.18, p = 0.03, respectively).
CONCLUSIONS
Among women with INOCA and relatively low risk factor including diabetes burden, renal microvascular dysfunction, measured by UACR, is related to coronary endothelial-dependent CMD. These results suggest that coronary endothelial-dependent function may be a manifestation of a systemic process. Enhancing efferent arteriolar vasodilatation in both coronary endothelial-dependent function and renal microvascular dysfunction pose potential targets for investigation and treatment.
CLINICAL TRIAL REGISTRATION
背景
冠状动脉微血管功能障碍（CMD）在有症状但无阻塞性冠状动脉疾病（INOCA）的女性中很常见。尿白蛋白/肌酐比值（UACR）是衡量肾脏微血管内皮功能障碍的指标。两者都是不良心血管事件的预测指标。目前尚不清楚 CMD 是否可能是全身过程的一种表现。我们评估了通过侵入性冠状动脉功能测试（CFT）测量的肾脏微血管功能障碍与 CMD 之间的关系。
方法和结果
我们测量了 152 名参加女性缺血综合征评估-冠状动脉血管功能障碍（WISE-CVD）研究（2008-2015 年）的女性的尿液白蛋白和肌酐，以提供 UACR，这些女性疑似患有 INOCA 并接受了 CFT。获得了内皮和非内皮依赖性冠状动脉微血管功能的侵入性 CFT 测量值。受试者分为可检测（≥20mg/g）和不可检测（<20mg/g）尿白蛋白组。该组的平均年龄为 54±11 岁，心脏危险因素负担中等，包括糖尿病患病率低，平均 UACR 为 12±55mg/g（范围 9.5-322.7mg/g）。总的来说，冠状动脉内皮依赖性变量（冷加压试验引起的冠状动脉血流和冠状动脉直径变化）与 log UACR 呈显著负相关（r=-0.17，p=0.05；r=-0.18，p=0.03）。
结论
在患有 INOCA 且糖尿病负担等危险因素相对较低的女性中，UACR 测量的肾脏微血管功能障碍与冠状动脉内皮依赖性 CMD 相关。这些结果表明，冠状动脉内皮依赖性功能可能是全身过程的一种表现。增强冠状动脉内皮依赖性功能和肾脏微血管功能障碍的传出小动脉舒张可能是一个潜在的研究和治疗目标。
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