Sucato Vincenzo, Novo Giuseppina, Madaudo Cristina, Di Fazio Luca, Vadalà Giuseppe, Caronna Nicola, D'Agostino Alessandro, Evola Salvatore, Tuttolomondo Antonino, Galassi Alfredo Ruggero
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University Hospital Paolo Giaccone, University of Palermo, 90127 Palermo, Italy.
J Clin Med. 2023 Jan 19;12(3):819. doi: 10.3390/jcm12030819.
The aim of the study is to evaluate the subclinical alterations of cardiac mechanics detected using speckle-tracking echocardiography and compare these data with the coronary angiography indices used during coronary angiography in a population of patients diagnosed with ischemia with no obstructive coronary artery (INOCA) and microvascular angina (MVA). The study included 85 patients admitted to our center between November 2019 and January 2022 who were diagnosed with INOCA compared with a control group of 70 healthy patients. A collection of anamnestic data and a complete cardiovascular physical examination, and echocardiogram at rest with longitudinal strain were performed for all patients. Furthermore, the TIMI frame count (TFC) for the three coronary vessels was calculated according to Gibson's indications. All parameters were compared with a control population with similar characteristics. Patients with INOCA compared to the control population showed statistically significant changes in the parameters assessed on the longitudinal strain analysis. In particular, patients with INOCA showed statistically significant changes in GLS (-16.71) compared to the control population (-19.64) ( = 0.003). In patients with INOCA, the total TIMI frame count (tTFC) correlated with the GLS value with a correlation coefficient of 0.418 ( = 0.021). In patients with angina, documented myocardial ischemia, the absence of angiographically significant stenosis (INOCA) and LVEF > 50%, the prevalence of microvascular dysfunction documented by TFC was extremely represented. A statistically significant reduction in GLS was observed in these patients. TFC and longitudinal strain, therefore, appear to be two reliable, sensitive and easily accessible methods for the study of alterations in coronary microcirculation and the characterization of patients with INOCA and microvascular angina.
本研究的目的是评估使用斑点追踪超声心动图检测到的心脏力学亚临床改变，并将这些数据与在诊断为无阻塞性冠状动脉缺血（INOCA）和微血管性心绞痛（MVA）的患者群体中进行冠状动脉造影时使用的冠状动脉造影指标进行比较。该研究纳入了2019年11月至2022年1月期间入住我们中心的85例被诊断为INOCA的患者，并与70例健康患者组成的对照组进行比较。对所有患者进行了病史数据收集、完整的心血管体格检查以及静息状态下的纵向应变超声心动图检查。此外，根据吉布森的指示计算了三根冠状动脉的心肌梗死溶栓治疗（TIMI）帧数（TFC）。所有参数均与具有相似特征的对照人群进行比较。与对照人群相比，INOCA患者在纵向应变分析中评估的参数有统计学显著变化。特别是，INOCA患者的整体纵向应变（GLS）（-16.71）与对照人群（-19.64）相比有统计学显著变化（P = 0.003）。在INOCA患者中，总TIMI帧数（tTFC）与GLS值相关，相关系数为0.418（P = 0.021）。在有胸痛、记录到心肌缺血、无血管造影显著狭窄（INOCA）且左心室射血分数（LVEF）>50%的患者中，TFC记录的微血管功能障碍患病率极高。在这些患者中观察到GLS有统计学显著降低。因此，TFC和纵向应变似乎是研究冠状动脉微循环改变以及INOCA和微血管性心绞痛患者特征的两种可靠、敏感且易于获得的方法。
