Rodriguez-Zanella Hugo, Arbucci Rosina, Fritche-Salazar Juan Francisco, Ortiz-Leon Xochitl Arely, Tuttolomondo Domenico, Lowenstein Diego Haber, Wierzbowska-Drabik Karina, Ciampi Quirino, Kasprzak Jarosław D, Gaibazzi Nicola, Lowenstein Jorge, Posada-Martinez Edith Liliana, Arias-Godinez Jose Antonio, de la Fuente-Mancera Juan C, Picano Eugenio
National Institute of Cardiology Ignacio Chavez, Mexico City 14080, Mexico.
Cardiodiagnosticos Investigaciones Medicas, Buenos Aires C1082, Argentina.
J Clin Med. 2022 Jan 28;11(3):711. doi: 10.3390/jcm11030711.
In patients with Ischemia and non-obstructive coronary artery stenosis (INOCA) wall motion is rarely abnormal during stress echocardiography (SE). Our aim was to determine if patients with INOCA and reduced coronary flow velocity reserve (CVFR) have altered cardiac mechanics using two-dimensional speckle-tracking echocardiography (2DSTE) during SE. In a prospective, multicenter, international study, we recruited 135 patients with INOCA. Overall, we performed high dose (0.84 mg/kg) dipyridamole SE with combined assessment of CVFR and 2DSTE. The population was divided in patients with normal CVFR (>2, group 1, = 95) and abnormal CVFR (≤2, group 2, = 35). Clinical and 2DSTE parameters were compared between groups. Feasibility was high for CFVR (98%) and 2DSTE (97%). A total of 130 patients (mean age 63 ± 12 years, 67 women) had complete flow and strain data. The two groups showed similar 2DSTE values at rest. At peak SE, Group 1 patients showed lower global longitudinal strain ( < 0.007), higher mechanical dispersion ( < 0.0005), lower endocardial ( < 0.001), and epicardial ( < 0.0002) layer specific strain. In patients with INOCA, vasodilator SE with simultaneous assessment of CFVR and strain is highly feasible. Coronary microvascular dysfunction is accompanied by an impairment of global and layer-specific deformation indices during stress.
在患有心肌缺血和非阻塞性冠状动脉狭窄（INOCA）的患者中，负荷超声心动图（SE）期间壁运动很少异常。我们的目的是确定患有INOCA且冠状动脉血流速度储备（CVFR）降低的患者在SE期间使用二维斑点追踪超声心动图（2DSTE）时心脏力学是否改变。在一项前瞻性、多中心、国际研究中，我们招募了135例INOCA患者。总体而言，我们进行了高剂量（0.84mg/kg）双嘧达莫SE，并联合评估CVFR和2DSTE。将人群分为CVFR正常（>2，第1组，n = 95）和CVFR异常（≤2，第2组，n = 35）的患者。比较两组之间的临床和2DSTE参数。CFVR（98%）和2DSTE（97%）的可行性很高。共有130例患者（平均年龄63±12岁，67例女性）有完整的血流和应变数据。两组在静息时显示出相似的2DSTE值。在SE峰值时，第1组患者表现出较低的整体纵向应变（P<0.007）、较高的机械离散度（P<0.0005）、较低的心内膜（P<0.001）和心外膜（P<0.0002）层特异性应变。在INOCA患者中，同时评估CFVR和应变的血管扩张剂SE是高度可行的。冠状动脉微血管功能障碍在负荷期间伴有整体和层特异性变形指数的损害。
