Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China.
Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
J Nucl Cardiol. 2023 Apr;30(2):684-701. doi: 10.1007/s12350-022-03038-w. Epub 2022 Aug 2.
A significant proportion of ischemia with non-obstructive coronary artery disease (INOCA) demonstrate coronary microvascular dysfunction (CMD), a condition associated with abnormal myocardial perfusion imaging (MPI) and adverse outcomes. Coronary angiography-derived index of microvascular resistance (caIMR) is a novel non-invasive technique to assess CMD. We aimed to investigate the prognostic value of combined caIMR and MPI by CZT SPECT in INOCA patients.
Consecutive 151 patients with chest pain and < 50% coronary stenosis who underwent coronary angiography and MPI within 3 months were enrolled. caIMR was calculated by computational pressure-flow dynamics. CMD was defined as caIMR ≥ 25. The endpoint was major adverse cardiac events (MACE: cardiovascular death, nonfatal myocardial infarction, revascularization, angina-related rehospitalization, heart failure, and stroke).
Of all INOCA patients, CMD was present in 93 (61.6%) patients. The prevalence of abnormal MPI was significantly higher in CMD compared with non-CMD patients (40.9% vs 13.8%, P < .001). CMD showed a higher risk of MACE than non-CMD patients. Patients with both CMD and abnormal MPI had the worst prognosis, followed by patients with CMD and normal MPI (log-rank P < .001). Cox regression analysis identified CMD (HR 3.121, 95%CI 1.221-7.974, P = .017) and MPI (HR 2.704, 95%CI 1.030-7.099, P = .043) as predictive of MACE. The prognostic value of INOCA patients enhanced significantly by adding CMD and MPI to the model with clinical risk factors (AUC = 0.777 vs 0.686, P = .030).
caIMR-derived CMD is associated with increased risk of MACE among INOCA patients. Patients with abnormalities on both caIMR and MPI had the worse outcomes.
相当一部分非阻塞性冠状动脉疾病（INOCA）患者存在冠状动脉微血管功能障碍（CMD），这与异常的心肌灌注成像（MPI）和不良预后有关。基于计算压力-血流动力学的冠状动脉造影衍生的微血管阻力指数（caIMR）是一种评估 CMD 的新型非侵入性技术。我们旨在研究 INOCA 患者的 caIMR 和 CZT SPECT 联合 MPI 的预后价值。
连续纳入 151 例胸痛且冠状动脉狭窄<50%的患者，这些患者在 3 个月内行冠状动脉造影和 MPI。通过计算压力-血流动力学来计算 caIMR。CMD 定义为 caIMR≥25。终点是主要不良心脏事件（MACE：心血管死亡、非致死性心肌梗死、血运重建、与心绞痛相关的再住院、心力衰竭和中风）。
在所有 INOCA 患者中，CMD 存在于 93 例（61.6%）患者中。CMD 患者 MPI 异常的发生率明显高于非 CMD 患者（40.9% vs. 13.8%，P<0.001）。CMD 患者的 MACE 风险高于非 CMD 患者。同时存在 CMD 和 MPI 异常的患者预后最差，其次是同时存在 CMD 和 MPI 正常的患者（对数秩检验 P<0.001）。Cox 回归分析发现 CMD（HR 3.121，95%CI 1.221-7.974，P=0.017）和 MPI（HR 2.704，95%CI 1.030-7.099，P=0.043）是 MACE 的预测因素。将 CMD 和 MPI 与临床危险因素加入模型后，INOCA 患者的预后价值显著增强（AUC=0.777 与 0.686，P=0.030）。
caIMR 衍生的 CMD 与 INOCA 患者的 MACE 风险增加相关。同时存在 caIMR 和 MPI 异常的患者结局最差。
