Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
Department of Medical Radiation Physics, Lund University, Lund, Sweden.
Clin Physiol Funct Imaging. 2024 Jan;44(1):89-99. doi: 10.1111/cpf.12854. Epub 2023 Sep 7.
Diagnosis and treatment of patients with suspected chronic coronary syndrome (CCS) currently relies on the degree of coronary artery stenosis and its significance for myocardial perfusion. However, myocardial perfusion can be affected by factors other than coronary stenosis. The aim of this study was to investigate to what extent sex, age, diabetes, hypertension and smoking affect quantitative myocardial perfusion, beyond the degree of coronary artery stenosis, in patients with suspected or established CCS. Eighty-six patients [median age 69 (range 46-86) years, 24 females] planned for elective coronary angiography due to suspected or established CCS were included. All patients underwent cardiac N-NH positron emission tomography to quantify myocardial perfusion at rest and stress. Lowest myocardial perfusion (perfusion ) at stress and rest and lowest myocardial perfusion reserve (MPR ) for all vessel territories was used as dependent variables in a linear mixed model. Independent variables were vessel territory, degree of coronary artery stenosis (as a continuous variable of 0%-100% stenosis), sex, age, diabetes, hypertension and smoking habits. Degree of coronary artery stenosis (p < 0.001), male sex (1.8 ± 0.6 vs. 2.3 ± 0.6 mL/min/g, p < 0.001), increasing age (p = 0.025), diabetes (1.6 ± 0.5 vs. 2.0 ± 0.6 mL/min/g, p = 0.023) and smoking (1.9 ± 0.6 vs. 2.1 ± 0.6 mL/min/g, p = 0.052) were independently associated with myocardial perfusion at stress. Degree of coronary artery stenosis (p < 0.001), age (p = 0.040), diabetes (1.8 ± 0.6 vs. 2.3 ± 0.7, p = 0.046) and hypertension (2.2 ± 0.7 vs. 2.5 ± 0.6, p = 0.033) were independently associated with MPR . Sex, increasing age, diabetes, hypertension and smoking affect myocardial perfusion independent of coronary artery stenosis in patients with suspected or established CCS. Thus, these factors need to be considered when assessing the significance of reduced quantitative myocardial perfusion of patients with suspected or established CCS.
诊断和治疗疑似慢性冠状动脉综合征（CCS）患者目前依赖于冠状动脉狭窄程度及其对心肌灌注的意义。然而，心肌灌注除了受冠状动脉狭窄程度的影响外，还可能受到其他因素的影响。本研究旨在探讨在疑似或确诊 CCS 患者中，性别、年龄、糖尿病、高血压和吸烟等因素对定量心肌灌注的影响程度，超出冠状动脉狭窄程度的影响。
由于疑似或确诊 CCS，计划进行选择性冠状动脉造影的 86 名患者[中位年龄 69（46-86）岁，24 名女性]被纳入本研究。所有患者均接受心脏 N-NH 正电子发射断层扫描以定量评估静息和应激状态下的心肌灌注。将所有血管区域的最低心肌灌注（灌注）和最低心肌灌注储备（MPR）作为依赖变量，纳入线性混合模型。独立变量为血管区域、冠状动脉狭窄程度（作为 0%-100%狭窄的连续变量）、性别、年龄、糖尿病、高血压和吸烟习惯。
研究发现，冠状动脉狭窄程度（p<0.001）、男性（1.8±0.6 与 2.3±0.6mL/min/g，p<0.001）、年龄增加（p=0.025）、糖尿病（1.6±0.5 与 2.0±0.6mL/min/g，p=0.023）和吸烟（1.9±0.6 与 2.1±0.6mL/min/g，p=0.052）与应激状态下的心肌灌注独立相关。冠状动脉狭窄程度（p<0.001）、年龄（p=0.040）、糖尿病（1.8±0.6 与 2.3±0.7，p=0.046）和高血压（2.2±0.7 与 2.5±0.6，p=0.033）与 MPR 独立相关。
性别、年龄增加、糖尿病、高血压和吸烟会影响疑似或确诊 CCS 患者的心肌灌注，独立于冠状动脉狭窄程度。因此，在评估疑似或确诊 CCS 患者定量心肌灌注减少的意义时，需要考虑这些因素。
