Bil Jacek, Pietraszek Natalia, Gil Robert J, Gromadziński Leszek, Onichimowski Dariusz, Jalali Rakesh, Kern Adam
Department of Invasive Cardiology, Center of Postgraduate Medical Education, Warsaw, Poland.
Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland.
Front Cardiovasc Med. 2022 Jun 30;9:933374. doi: 10.3389/fcvm.2022.933374. eCollection 2022.
Coronary microcirculatory dysfunction is a meaningful factor in the development of ischemic heart disease. We investigated the relationship between coronary microvascular spasm and complete blood count indices.
Between 2010 and 2013, we performed acetylcholine test (AChT) in subjects with suspicion of angina evoked by epicardial coronary spasm or coronary microvascular spasm according to COVADIS criteria. We administered acetylcholine in increasing doses of 25, 50, and 75 μg into the right coronary artery and 25, 50, and 100 μg into the left coronary artery. Patients were followed up for 60 months.
In total, 211 patients (60.5 ± 7.8 years, 67.8% women) were included in the study. The AChT revealed angina due to epicardial coronary spasm in 99 patients (46.9%) and coronary microvascular spasm in 72 (34.1%). White blood cell (WBC), red blood cell distribution width (RDW), platelets (PLT), mean platelet volume (MPV), and platelet distribution width (PDW) values were significantly higher in patients with coronary microvascular spasm than in patients from the other two groups, i.e., epicardial coronary spasm and negative AChT. PDW showed the highest sensitivity (65%) and specificity (72%) at the cutoff value of 15.32% [area under the curve, 0.723; 95% confidence interval (CI) 0.64-0.83; < 0.001]. Independent risk factors for coronary microvascular spasm diagnosis using AChT were as follows: female sex (OR, 1.199), PDW (OR, 2.891), and RDW (OR, 1.567).
PDW and RDW are significantly associated with the diagnosis of coronary microvascular spasm in patients undergoing AChT as well as with poor prognosis in such patients at 5 years.
冠状动脉微循环功能障碍是缺血性心脏病发展过程中的一个重要因素。我们研究了冠状动脉微血管痉挛与全血细胞计数指标之间的关系。
在2010年至2013年期间，我们根据COVADIS标准，对怀疑由心外膜冠状动脉痉挛或冠状动脉微血管痉挛诱发心绞痛的患者进行了乙酰胆碱试验（AChT）。我们以递增剂量25、50和75μg向右冠状动脉注射乙酰胆碱，以25、50和100μg向左冠状动脉注射。对患者进行了60个月的随访。
共有211例患者（年龄60.5±7.8岁，女性占67.8%）纳入研究。AChT显示，99例患者（46.9%）因心外膜冠状动脉痉挛诱发心绞痛，72例患者（34.1%）因冠状动脉微血管痉挛诱发心绞痛。冠状动脉微血管痉挛患者的白细胞（WBC）、红细胞分布宽度（RDW）、血小板（PLT）、平均血小板体积（MPV）和血小板分布宽度（PDW）值显著高于其他两组患者，即心外膜冠状动脉痉挛患者和AChT阴性患者。在截断值为15.32%时，PDW显示出最高的敏感性（65%）和特异性（72%）[曲线下面积，0.723；95%置信区间（CI）0.64 - 0.83；P < 0.001]。使用AChT诊断冠状动脉微血管痉挛的独立危险因素如下：女性（比值比，1.199）、PDW（比值比，2.891）和RDW（比值比，1.567）。
PDW和RDW与接受AChT的患者冠状动脉微血管痉挛的诊断显著相关，并且与这些患者5年的不良预后相关。
