冠状动脉慢血流的目测估计与基于侵入性导丝的冠状动脉微血管功能障碍的诊断无关。
Visual Estimates of Coronary Slow Flow Are Not Associated With Invasive Wire-Based Diagnoses of Coronary Microvascular Dysfunction.
机构信息
Sarah Ross Soter Center for Women's Cardiovascular Research (K.L.H., A.J., A.H., H.R.R., N.R.S.), New York University Grossman School of Medicine.
Leon H. Charney Division of Cardiology, Department of Medicine (E.L., W.B., C.S.-G., A.F., A.H., H.R.R., N.R.S.), New York University Grossman School of Medicine.
出版信息
Circ Cardiovasc Interv. 2024 Jun;17(6):e013902. doi: 10.1161/CIRCINTERVENTIONS.123.013902. Epub 2024 Apr 7.
BACKGROUND
Coronary slow flow (CSF) by invasive coronary angiography is frequently understood to be an indicator of coronary microvascular dysfunction (CMD) in patients with ischemia with nonobstructive coronary arteries. However, the relationship between visual estimates of CSF and quantitative wire-based invasive diagnosis of CMD is uncertain.
METHODS
We prospectively enrolled adults aged ≥18 years with stable ischemic heart disease who were referred for invasive coronary angiography. Individuals with ≥50% epicardial coronary artery stenosis were excluded. Invasive coronary angiography was reviewed for CSF, defined as ≥3 cardiac cycles to opacify distal vessels with contrast. Coronary function testing was performed in the left anterior descending coronary artery using bolus coronary thermodilution techniques to measure coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR). Invasively determined CMD was defined as abnormal CFR (<2.5), abnormal IMR (≥25), or both.
RESULTS
Among 104 participants, the median age was 61.5 years and 79% were female. The median CFR was 3.6 (interquartile range, 2.5-4.7) and the median IMR was 21 (interquartile range, 13.3-28.0). Overall, 24.0% of participants had abnormal CFR, 34.6% had abnormal IMR, and 48.1% had a final diagnosis of invasively determined CMD. CSF was present in 23 participants (22.1%). The proportions of patients with CMD (56.5% versus 45.7%; =0.36), abnormal CFR (17.4% versus 25.9%; =0.40), and abnormal IMR (43.5% versus 32.1%; =0.31) were not different in patients with versus without CSF.
CONCLUSIONS
Among patients with ischemia with nonobstructive coronary artery, CSF was not associated with abnormal CFR, IMR, or either abnormal CFR or IMR. CSF is not a reliable angiographic surrogate of abnormal CFR or IMR as determined by invasive, wire-based physiology testing.
REGISTRATION
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03537586.
背景
经侵入性冠状动脉造影显示的冠状动脉慢血流（CSF）通常被认为是有缺血但无阻塞性冠状动脉的患者的冠状动脉微血管功能障碍（CMD）的一个指标。然而，CSF 的视觉评估与基于导丝的 CMD 定量侵入性诊断之间的关系尚不确定。
方法
我们前瞻性纳入了年龄≥18 岁、因稳定型缺血性心脏病而接受侵入性冠状动脉造影的成年人。排除有≥50%的外膜冠状动脉狭窄的患者。对侵入性冠状动脉造影进行了 CSF 的回顾性分析，CSF 定义为用对比剂使远端血管显影需要≥3 个心动周期。使用冠状动脉热稀释技术对左前降支冠状动脉进行冠状动脉功能测试，以测量冠状动脉血流储备（CFR）和微血管阻力指数（IMR）。通过侵入性方法确定 CMD 为异常 CFR（<2.5）、异常 IMR（≥25）或两者兼有。
结果
在 104 名参与者中，中位年龄为 61.5 岁，79%为女性。中位 CFR 为 3.6（四分位间距，2.5-4.7），中位 IMR 为 21（四分位间距，13.3-28.0）。总体而言，24.0%的参与者存在异常 CFR，34.6%存在异常 IMR，48.1%有最终诊断为 CMD。23 名患者（22.1%）存在 CSF。CMD 患者（56.5%与 45.7%；=0.36）、异常 CFR（17.4%与 25.9%；=0.40）和异常 IMR（43.5%与 32.1%；=0.31）的比例在有 CSF 与无 CSF 的患者中并无差异。
结论
在缺血但无阻塞性冠状动脉的患者中，CSF 与异常 CFR、IMR 或异常 CFR 和 IMR 均无相关性。CSF 不能作为通过有创、基于导丝的生理学测试确定的异常 CFR 或 IMR 的可靠血管造影替代指标。
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