Department of Clinical Physiology, Lund University and Skåne University Hospital, Lund, Sweden.
Clin Physiol Funct Imaging. 2022 May;42(3):208-219. doi: 10.1111/cpf.12750. Epub 2022 Mar 28.
Patients with chest pain may have normal coronary arteries and suffer from microvascular angina (MVA). The aim of this study was to determine if patients with suspected MVA have lower global myocardial perfusion (global MP) during adenosine stress compared with healthy controls and coronary artery disease (CAD) patients and to determine if there are sex differences in global MP.
Twenty-three patients with suspected MVA (66 ± 11 years), 19 CAD patients (69 ± 5 years) with stress-induced ischaemia and 24 healthy controls (61 ± 10 years) underwent cardiac magnetic resonance (CMR) including coronary sinus flow measurements and first-pass perfusion at rest and during adenosine stress. Global MP was quantified as coronary sinus flow normalized to left ventricular mass.
Global perfusion was lower during stress in patients with suspected MVA (2.9 ± 1.0 ml/min/g) compared with healthy volunteers (3.7 ± 1.1 ml/min/g, p = 0.018), but higher compared with CAD patients (2.0 ± 0.9 ml/min/g, p = 0.019). Female controls had higher global MP than male controls both at rest (1.0 ± 0.3 vs. 0.7 ± 0.2 ml/min/g, p = 0.003) and during stress (4.4 ± 1.0 vs. 3.1 ± 0.6 ml/min/g, p = 0.001). Furthermore, females with suspected MVA showed higher global MP than males with suspected MVA (3.3 ± 1.0 vs. 2.4 ± 0.7, p = 0.04).
Patients with suspected MVA have lower global MP at stress than healthy volunteers but higher than patients with CAD. Furthermore, there seems to be a sex difference in global MP at stress both in healthy volunteers and in patients with suspected MVA, with higher global MP in females, which implies a need for sex-specific normal limits when assessing quantitative MP.
胸痛患者可能存在正常冠状动脉，并患有微血管性心绞痛（MVA）。本研究旨在确定疑似 MVA 患者在腺苷应激期间的整体心肌灌注（global MP）是否低于健康对照者和冠心病（CAD）患者，并确定整体 MP 是否存在性别差异。
23 例疑似 MVA 患者（66±11 岁）、19 例 CAD 患者（69±5 岁，有应激性缺血）和 24 例健康对照者（61±10 岁）接受心脏磁共振（CMR）检查，包括冠状窦流量测量和静息及腺苷应激时的首次通过灌注。将整体灌注定义为冠状窦流量与左心室质量的比值。
疑似 MVA 患者在应激时的整体灌注低于健康志愿者（2.9±1.0ml/min/g 比 3.7±1.1ml/min/g，p=0.018），但高于 CAD 患者（2.0±0.9ml/min/g，p=0.019）。女性对照者在静息时和应激时的整体 MP 均高于男性对照者（分别为 1.0±0.3 比 0.7±0.2ml/min/g，p=0.003；4.4±1.0 比 3.1±0.6ml/min/g，p=0.001）。此外，疑似 MVA 的女性患者的整体 MP 高于疑似 MVA 的男性患者（3.3±1.0 比 2.4±0.7，p=0.04）。
疑似 MVA 患者在应激时的整体 MP 低于健康志愿者，但高于 CAD 患者。此外，在健康志愿者和疑似 MVA 患者中，应激时的整体 MP 似乎存在性别差异，女性的整体 MP 更高，这意味着在评估定量 MP 时需要有针对性别制定正常范围。
