射血分数保留的心力衰竭患者的心肌血流储备

The myocardial flow reserve in patients with heart failure with preserved ejection fraction.

作者信息

Mochula Andrew V, Kopeva Kristina V, Maltseva Alina N, Grakova Elena V, Gulya Marina, Smorgon Andrey V, Gusakova Anna, Zavadovsky Konstantin V

机构信息

Cardiology Research Institute, Tomsk National Research Medical Center (TNRMC), Russian Academy of Sciences (RAS), 111a, Kievskaya Str., Tomsk, 634012, Russian Federation.

出版信息

Heart Vessels. 2023 Mar;38(3):348-360. doi: 10.1007/s00380-022-02161-5. Epub 2022 Sep 1.

DOI:10.1007/s00380-022-02161-5

PMID:36045268

Abstract

To evaluate the myocardial flow reserve (MFR) and myocardial blood flow (MBF) parameters in patients with heart failure with preserved ejection fraction (HFpEF) and to assess their relationship with the severity of HF and the levels of soluble ST2 (sST2). A total of 59 consecutive patients (median age of 65.0 (58.0; 69.0) years) with non-obstructive coronary artery disease (CAD) and preserved EF were enrolled. Serum levels biomarkers were measured by enzyme immunoassay. MBF and MFR parameters were evaluated by dynamic CZT-SPECT. All patients were divided into two groups: group 1 comprised patients (n = 41) with HFpEF, and group 2 comprised those (n = 18) without HFpEF. In group 1 global MFR (gMFR) values were lower by 27.8% (p = 0.003) than in group 2. The values of gMFR correlated with NT-proBNP (r = - 0.290) and sST2 (r = -0.331) levels. Based on ROC-analysis, gMFR ≤ 2.27 (AUC = 0.746; p < 0.001) were associated with the presence of HFpEF. In patients with HFpEF (n = 41) the values of gMFR were related to NYHA classes (p < 0.001) and the parameters of diastolic dysfunction (p < 0.001). The values of gMFR ≤ 2.27 may be used for the evaluation of microvascular changes in patients with HFpEF and non-obstructive CAD.

摘要

评估射血分数保留的心力衰竭（HFpEF）患者的心肌血流储备（MFR）和心肌血流量（MBF）参数，并评估它们与心力衰竭严重程度及可溶性ST2（sST2）水平的关系。共纳入59例连续性非阻塞性冠状动脉疾病（CAD）且射血分数保留的患者（中位年龄65.0（58.0；69.0）岁）。血清水平生物标志物采用酶免疫法测定。MBF和MFR参数通过动态CZT单光子发射计算机断层显像（SPECT）评估。所有患者分为两组：第1组包括41例HFpEF患者，第2组包括18例无HFpEF患者。第1组的整体MFR（gMFR）值比第2组低27.8%（p = 0.003）。gMFR值与N末端B型利钠肽原（NT-proBNP）（r = -0.290）和sST2（r = -0.331）水平相关。基于ROC分析，gMFR≤2.27（曲线下面积（AUC）= 0.746；p < 0.001）与HFpEF的存在相关。在HFpEF患者（n = 41）中，gMFR值与纽约心脏协会（NYHA）分级（p < 0.001）和舒张功能障碍参数（p < 0.001）相关。gMFR≤2.27的值可用于评估HFpEF和非阻塞性CAD患者的微血管变化。