Cortigiani Lauro, Carpeggiani Clara, Meola Laura, Djordjevic-Dikic Ana, Bovenzi Francesco, Picano Eugenio
Cardiology Division, San Luca Hospital, 55100 Lucca, Italy.
CNR Institute of Clinical Physiology, 56125 Pisa, Italy.
J Clin Med. 2021 Dec 23;11(1):52. doi: 10.3390/jcm11010052.
. Patients with ischemia and normal coronary arteries (INOCA) may show abnormal cardiac sympathetic function, which could be unmasked as a reduced heart rate reserve (HRR) during dipyridamole stress echocardiography (SE). . To assess whether HRR during dipyridamole SE predicts outcome. . Dipyridamole SE was performed in 292 patients with INOCA. HRR was measured as peak/rest heart rate and considered abnormal when ≤1.22 (≤1.17 in presence of permanent atrial fibrillation). All-cause death was the only endpoint. . HRR during SE was normal in 183 (63%) and abnormal in 109 patients (37%). During a follow-up of 10.4 ± 5.5 years, 89 patients (30%) died. The 15-year mortality rate was 27% in patients with normal and 54% in those with abnormal HRR ( < 0.0001). In a multivariable analysis, a blunted HRR during SE was an independent predictor of outcome (hazard ratio 1.86, 95% confidence intervals 1.20-2.88; = 0.006) outperforming inducible ischemia. . A blunted HRR during dipyridamole SE predicts a worse survival in INOCA patients, independent of inducible ischemia.
缺血且冠状动脉正常（INOCA）的患者可能表现出心脏交感神经功能异常，这在双嘧达莫负荷超声心动图（SE）期间可能表现为心率储备（HRR）降低。为评估双嘧达莫SE期间的HRR是否可预测预后。对292例INOCA患者进行了双嘧达莫SE检查。HRR通过峰值/静息心率测量，当≤1.22（永久性心房颤动时≤1.17）时被认为异常。全因死亡是唯一的终点。SE期间HRR正常的患者有183例（63%），异常的有109例（37%）。在10.4±5.5年的随访期间，89例患者（30%）死亡。HRR正常的患者15年死亡率为27%，HRR异常的患者为54%（P<0.0001）。在多变量分析中，SE期间HRR降低是预后的独立预测因素（风险比1.86，95%置信区间1.20 - 2.88；P = 0.006），优于诱发的缺血。双嘧达莫SE期间HRR降低可预测INOCA患者较差的生存率，与诱发的缺血无关。
