Teragawa Hiroki, Oshita Chikage, Uchimura Yuko, Akazawa Ryota, Orita Yuichi
Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan.
J Clin Med. 2021 Dec 27;11(1):130. doi: 10.3390/jcm11010130.
In the clinical setting; the microvascular vasodilatory function test (MVFT) with a pressure wire has been used in ischaemia patients with non-obstructive coronary arteries (INOCA), including vasospastic angina (VSA) and microvascular angina (MVA). The exact factors that affect the microvascular vasodilatory function (MVF) in such patients are still unknown. We aimed to identify the factors, including clinical parameters and lesion characteristics, affecting the MVF in such patients.
A total of 53 patients who underwent coronary angiography, spasm provocation tests (SPTs) and MVFTs were enrolled. In the MVFT, the coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) were measured. Of the 53 patients, MVFT data in the left anterior descending coronary artery (LAD) were obtained from 49 patients, and the clinical parameters were checked in all of them. Based on the results of the SPT, coronary spasms were divided into focal spasm, diffuse spasm, and microvascular spasm (MVS). To assess the lesion characteristics influencing MVF, MVFT data were compared according to the types of coronary spasm and coronary vessels in 73 vessels of the 53 patients.
In 49 patients who underwent the MVFT in the LAD, the IMR was higher in active smokers ( = 7) than in former smokers ( = 15) and never smokers ( = 27, < 0.01). In the 73 coronary arteries in this study, the type of coronary spasm did not correlate with the CFR or IMR, whereas a higher IMR were more frequently observed in cases of focal spasm than in cases of diffuse spasm ( = 0.03). In addition, the IMR was higher in the right coronary artery (RCA) than in the LAD ( = 0.02).
These results indicate that the smoking status affected the MVF in patients with INOCA, suggesting the possibility of improvement in the MVF by smoking cessation in such patients. In addition, in the assessment of MVF, it may be important to take into account which coronary artery or types of coronary spasm are being evaluated.
在临床环境中，使用压力导丝进行的微血管舒张功能测试（MVFT）已用于非阻塞性冠状动脉（INOCA）的缺血患者，包括血管痉挛性心绞痛（VSA）和微血管性心绞痛（MVA）。影响此类患者微血管舒张功能（MVF）的确切因素仍不清楚。我们旨在确定影响此类患者MVF的因素，包括临床参数和病变特征。
共纳入53例接受冠状动脉造影、痉挛激发试验（SPT）和MVFT的患者。在MVFT中，测量冠状动脉血流储备（CFR）和微循环阻力指数（IMR）。53例患者中，49例获得左前降支冠状动脉（LAD）的MVFT数据，并检查所有患者的临床参数。根据SPT结果，冠状动脉痉挛分为局灶性痉挛、弥漫性痉挛和微血管痉挛（MVS）。为了评估影响MVF的病变特征，根据53例患者73支血管的冠状动脉痉挛类型和冠状动脉血管比较MVFT数据。
在49例接受LAD的MVFT的患者中，现吸烟者（n = 7）的IMR高于既往吸烟者（n = 15）和从不吸烟者（n = 27，P < 0.01）。在本研究的73支冠状动脉中，冠状动脉痉挛类型与CFR或IMR无关，而局灶性痉挛病例中IMR高于弥漫性痉挛病例（P = 0.03）。此外，右冠状动脉（RCA）的IMR高于LAD（P = 0.02）。
这些结果表明吸烟状态影响INOCA患者的MVF，提示此类患者戒烟可能改善MVF。此外，在评估MVF时，考虑评估的是哪支冠状动脉或冠状动脉痉挛类型可能很重要。
