Department of Cardiology, University of Missouri-Kansas City, Kansas City, MO, USA.
Department of Cardiology, Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO, 64111, USA.
J Nucl Cardiol. 2023 Dec;30(6):2666-2675. doi: 10.1007/s12350-023-03343-y. Epub 2023 Jul 31.
Peripheral artery disease (PAD) and coronary vascular dysfunction are common in patients with cardiometabolic disease. Neither the prevalence of coronary vascular dysfunction among patients with PAD nor the prognostic impact with these two conditions present together has been well studied.
Consecutive patients who underwent PET MPI were analyzed for presence of coronary vascular dysfunction [myocardial blood flow reserve (MBFR) < 2]. Cox regression was used to examine the association of reduced MBFR with mortality in patients with PAD, as well as the association of comorbid MBFR < 2 and PAD with all-cause death.
Among 13,940 patients, 1936 (14%) had PAD, 7782 (56%) had MBFR < 2 and 1346 (10%) had both PAD and MBFR < 2. Reduced MBFR was very common (69.5%) and was associated with increased risk of all-cause death (HR 1.69, 95%CI 1.32, 2.16, p < 0.01) in patients with PAD. Patients with both PAD and MBFR < 2, and those with either PAD or reduced MBFR had increased risk of death compared to those with neither condition: PAD + MBFR < 2 [(HR 95%CI), 2.30; 1.97-2.68], PAD + MBFR ≥ 2 (1.37; (1.08-1.72), PAD - MBFR < 2 (1.98; 1.75-2.25), p < 0.001 for all).
Coronary vascular dysfunction was common in patients with PAD and was associated with increased risk of death.
周围血管疾病（PAD）和冠状动脉血管功能障碍在心脏代谢疾病患者中很常见。患有 PAD 患者的冠状动脉血管功能障碍的患病率以及这两种情况同时存在的预后影响尚未得到充分研究。
对接受 PET MPI 检查的连续患者进行分析，以确定是否存在冠状动脉血管功能障碍[心肌血流储备（MBFR）<2]。使用 Cox 回归检查在 PAD 患者中，MBFR 降低与死亡率之间的关联，以及共患 MBFR<2 和 PAD 与全因死亡之间的关联。
在 13940 名患者中，1936 名（14%）患有 PAD，7782 名（56%）MBFR<2，1346 名（10%）同时患有 PAD 和 MBFR<2。MBFR 降低非常常见（69.5%），并且与 PAD 患者的全因死亡风险增加相关（HR 1.69，95%CI 1.32，2.16，p<0.01）。同时患有 PAD 和 MBFR<2 的患者，以及患有 PAD 或 MBFR 降低的患者，与既无 PAD 又无 MBFR 降低的患者相比，死亡风险增加：PAD+MBFR<2 [（HR 95%CI），2.30；1.97-2.68]，PAD+MBFR≥2（1.37；1.08-1.72），PAD-MBFR<2（1.98；1.75-2.25），p<0.001）。
冠状动脉血管功能障碍在 PAD 患者中很常见，与死亡风险增加相关。
