使用应力灌注心脏磁共振成像评估糖化血红蛋白A1c与冠状动脉微血管疾病患者微循环血液灌注的关系：一项观察性研究

HbA1c is related to microcirculation blood perfusion in patients with coronary microvascular disease using stress perfusion cardiac magnetic resonance: An observational study.

作者信息

Yong JingWen, Tian JinFan, Zuo HuiJuan, Cao JiaXin, Kong HuiHui, Zhao Xin, Yang XueYao, Zhang HongJia, He Yi, Song XianTao

机构信息

Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, China.

Department of Community Health Research, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing Anzhen Hospital, Capital Medical University, China.

出版信息

Microvasc Res. 2023 May;147:104493. doi: 10.1016/j.mvr.2023.104493. Epub 2023 Feb 3.

DOI:10.1016/j.mvr.2023.104493

PMID:36738986

Abstract

BACKGROUND

In coronary microvascular disease (CMD) patients, the incidence of major adverse cardiovascular events (MACEs) in patients with myocardial perfusion reserve index (MPRI) ≤ 1.47 is three times higher than that in MPRI > 1.47. We investigated whether the increase of glycated hemoglobin A1c (HbA1c) could increase the risk of MPRI ≤1.47 in diabetic and non-diabetic patients.

METHODS

From November 2019, patients with ischemic symptoms but without obstructive coronary disease were screened. Use MPRI measured by stress perfusion cardiac magnetic resonance (CMR) to reflect microcirculation blood perfusion, and MPRI <2.5 were included. The patients were divided into two groups based on MPRI was greater or <1.47. The risk factors for CMD were explored using logistic regression analysis.

RESULTS

A total of 80 patients with an MPRI of 1.69 ± 0.79 were included. CMD patients with an MPRI of ≤1.47(n = 33) were higher than MPRI of >1.47(n = 47) in age, presence of diabetes mellitus, fasting blood glucose levels and HbA1c levels (P < 0.05). In non-diabetic patients, increased HbA1c was associated with the risk of MPRI≤1.47 (OR = 0.017, 95%CI: 0.050-1.107, P = 0.045). Compared with non-diabetic patients with HbA1c < 6.0, non-diabetic patients with HbA1c ≥ 6.0 increased the risk of MPRI of ≤1.47 (OR = 0.219, 95%CI: 0.069-0.697, P = 0.010). In diabetic patients, HbA1c was not associated with the risk of MPRI of ≤1.47 (OR = 1.043, 95%CI: 0.269, 4.044, P = 0.952). And compared with non-diabetic patients with HbA1c <6.0, diabetic patients with HbA1c <6.0 (OR = 0.917, 95%CI: 0.233-3.610, P = 0.901) or ≥6.0 (OR = 0.326, 95%CI: 0.073-1.446, P = 0.140), the risk of MPRI ≤ 1.47 was not further increased.

CONCLUSIONS

In non-diabetic patients, elevated HbA1c is related to MPRI≤1.47(a value increased incidence of MACEs). Therefore, in patients with undiagnosed diabetes, early management of glycosylated hemoglobin is very important.

TRIAL REGISTRATION

This clinical trial has been registered in the Chinese clinical Trial Registry with an identifier: ChiCTR1900025810.

摘要

背景

在冠状动脉微血管疾病（CMD）患者中，心肌灌注储备指数（MPRI）≤1.47的患者发生主要不良心血管事件（MACE）的发生率是MPRI>1.47患者的三倍。我们研究了糖化血红蛋白A1c（HbA1c）升高是否会增加糖尿病和非糖尿病患者MPRI≤1.47的风险。

方法

自2019年11月起，对有缺血症状但无阻塞性冠状动脉疾病的患者进行筛查。使用通过负荷灌注心脏磁共振成像（CMR）测量的MPRI来反映微循环血液灌注，纳入MPRI<2.5的患者。根据MPRI大于或<1.47将患者分为两组。使用逻辑回归分析探索CMD的危险因素。

结果

共纳入80例MPRI为1.69±0.79的患者。MPRI≤1.47的CMD患者（n=33）在年龄、糖尿病存在情况、空腹血糖水平和HbA1c水平方面高于MPRI>1.47的患者（n=47）（P<0.05）。在非糖尿病患者中，HbA1c升高与MPRI≤1.47的风险相关（OR=0.017，95%CI：0.050-1.107，P=0.045）。与HbA1c<6.0的非糖尿病患者相比，HbA1c≥6.0的非糖尿病患者MPRI≤1.47的风险增加（OR=0.219，95%CI：0.069-0.697，P=0.010）。在糖尿病患者中，HbA1c与MPRI≤1.47的风险无关（OR=1.043，95%CI：0.269，4.044，P=0.952）。并且与HbA1c<6.0的非糖尿病患者相比，HbA1c<6.0（OR=0.917，95%CI：0.233-3.610，P=0.901）或≥6.0（OR=0.326，95%CI：0.073-1.446，P=0.140）的糖尿病患者，MPRI≤1.47的风险未进一步增加。