Sakai Akiko, Nagao Michinobu, Yamamoto Atsushi, Nakao Risako, Arashi Hiroyuki, Momose Mitsuru, Sato Kayoko, Yamaguchi Junichi
Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo 162-8666, Japan.
Department of Diagnostic Imaging & Nuclear Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo 162-8666, Japan.
Int J Cardiol. 2024 Jan 15;395:131392. doi: 10.1016/j.ijcard.2023.131392. Epub 2023 Sep 24.
Ischemia with no obstructive coronary arteries (INOCA), a chronic disorder with a poor prognosis, remains challenging to diagnose. N-ammonia positron emission tomography (13NH3 PET), which can quantify microcirculation, is its most reliable detection method. We aimed to investigate the differences in 13NH3 PET findings between INOCA and coronary artery disease (CAD).
Overall, consecutive 433 patients with known or suspected CAD underwent adenosine-stress 13NH3 PET. Based on the European Society of Cardiology guidelines, INOCA was defined as typical angina without coronary stenosis (INOCA n = 45, CAD n = 293, no CAD n = 95). Papillary muscle ischemia (PMI) and global myocardial flow reserve (MFR) were examined as microvascular injuries using 13NH3 PET.
PMI was observed significantly more frequently in patients with INOCA than in those with CAD (40.0% vs. 11.6%, respectively; p = 0.02). Global MFR (1.84 ± 0.54 vs. 2.08 ± 0.66, respectively; p < 0.0001) and reactive hyperemia index were significantly lower in patients with INOCA than in those with CAD. Forty-five major adverse cardiac events (MACE) were recorded in a median follow-up time of 827 days. Kaplan-Meier analysis revealed that the survival rate worsened in patients with INOCA and PMI (log-rank test, p = 0.001). In the Cox proportional hazards model, PMI was an independent predictive factor for MACE (odds ratio, 4.16; 95% confidence interval, 2.13-8.15; p < 0.0001).
PMI presence and decreased MFR were 13NH3 PET findings characteristic of INOCA. 13NH3 PET can be used to monitor the treatment course.
无阻塞性冠状动脉的心肌缺血（INOCA）是一种预后较差的慢性疾病，其诊断仍然具有挑战性。能够量化微循环的N-氨正电子发射断层扫描（13NH3 PET）是其最可靠的检测方法。我们旨在研究INOCA与冠状动脉疾病（CAD）患者13NH3 PET检查结果的差异。
总共433例已知或疑似CAD的患者连续接受了腺苷负荷13NH3 PET检查。根据欧洲心脏病学会指南，INOCA被定义为无冠状动脉狭窄的典型心绞痛（INOCA组n = 45，CAD组n = 293，非CAD组n = 95）。使用13NH3 PET检查乳头肌缺血（PMI）和整体心肌血流储备（MFR）作为微血管损伤情况。
INOCA患者中观察到PMI的频率显著高于CAD患者（分别为40.0%和11.6%；p = 0.02）。INOCA患者的整体MFR（分别为1.84±0.54和2.08±0.66；p < 0.0001）和反应性充血指数显著低于CAD患者。在中位随访时间827天内记录了45例主要不良心脏事件（MACE）。Kaplan-Meier分析显示，INOCA合并PMI患者的生存率较差（对数秩检验，p = 0.001）。在Cox比例风险模型中，PMI是MACE的独立预测因素（比值比，4.16；95%置信区间，2.13 - 8.15；p < 0.0001）。
PMI的存在和MFR降低是INOCA患者13NH3 PET检查的特征性表现。13NH3 PET可用于监测治疗过程。
