Montisci Roberta, Marchetti Maria Francesca, Ruscazio Massimo, Biddau Mattia, Secchi Sara, Zedda Norma, Casula Roberto, Tuveri Francesca, Kerkhof Peter Lm, Meloni Luigi, Tona Francesco
Clinical Cardiology, AOU Cagliari, Department of Clinical Sciences and Public Health, University of Cagliari, Italy.
Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
J Public Health Res. 2023 Jun 10;12(2):22799036231181716. doi: 10.1177/22799036231181716. eCollection 2023 Apr.
Evaluation of coronary flow velocity reserve (CFVR) is the physiological approach to assess the severity of coronary stenosis and microvascular dysfunction. Impaired CFVR occurs frequently in women with suspected or known coronary artery disease. The aim of this study was to assess the role of CFVR to predict long-term cardiovascular event rate in women with unstable angina (UA) without obstructive coronary artery stenosis.
CFVR in left anterior descending coronary artery was assessed by adenosine transthoracic echocardiograhy in 161 women admitted at our Department with UA and without obstructive coronary artery disease.
During a mean FU of 32.5 ± 19.6 months, 53 cardiac events occurred: 6 nonfatal acute myocardial infarction, 22 UA, 7 coronary revascularization by percutaneous transluminal coronary angioplasty, 1 coronary bypass surgery, 3 ischemic stroke, and 8 episodes of congestive heart failure with preserved ejection fraction and 6 cardiac deaths. Using a ROC curve analysis, CFVR 2.14 was the best predictor of cardiac events and was considered as abnormal CFVR. Abnormal CFVR was associated with lower cardiac event-free survival (30 vs 80%, p < 0.0001). During FU, 70% of women with reduced CFVR had cardiac events whereas only 20% with normal CFVR (p = 0.0001). At multivariate Cox analysis, smoke habitus (p = 0.003), metabolic syndrome (p = 0.01), and CFVR (p < 0.0001) were significantly associated with cardiac events at FU.
Noninvasive CFVR provides an independent predictor of cardiovascular prognosis information in women with UA without obstructive coronary artery disease whereas, impaired CFVR seems to be associated with higher CV events at FU.
评估冠状动脉血流储备（CFVR）是评估冠状动脉狭窄严重程度和微血管功能障碍的生理学方法。CFVR受损在疑似或已知冠状动脉疾病的女性中经常出现。本研究的目的是评估CFVR在预测无阻塞性冠状动脉狭窄的不稳定型心绞痛（UA）女性长期心血管事件发生率中的作用。
通过经胸腺苷超声心动图对我院收治的161例无阻塞性冠状动脉疾病的UA女性患者的左前降支冠状动脉CFVR进行评估。
在平均32.5±19.6个月的随访期间，发生了53次心脏事件：6例非致命性急性心肌梗死、22例UA、7例经皮冠状动脉腔内血管成形术进行的冠状动脉血运重建、1例冠状动脉搭桥手术、3例缺血性中风、8例射血分数保留的充血性心力衰竭发作和6例心源性死亡。使用ROC曲线分析，CFVR 2.14是心脏事件的最佳预测指标，被认为是异常CFVR。异常CFVR与较低的无心脏事件生存率相关（30%对80%，p<0.0001）。在随访期间，CFVR降低的女性中有70%发生了心脏事件，而CFVR正常的女性中只有20%发生了心脏事件（p=0.0001）。在多变量Cox分析中，吸烟习惯（p=0.003）、代谢综合征（p=0.01）和CFVR（p<0.0001）与随访期间的心脏事件显著相关。
无创CFVR为无阻塞性冠状动脉疾病的UA女性提供了心血管预后信息的独立预测指标，而CFVR受损似乎与随访期间较高的心血管事件相关。
