Zornitzki Lior, Shetrit Aviel, Freund Ophir, Frydman Shir, Banai Ariel, Amar Shamir Reut, Ben-Shoshan Jeremy, Arbel Yaron, Banai Shmuel, Konigstein Maayan
Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with Tel Aviv University School of Medicine, Tel Aviv, Israel.
Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, Affiliated with Tel Aviv University School of Medicine, Tel Aviv, Israel.
Cardiology. 2024;149(5):455-462. doi: 10.1159/000539102. Epub 2024 Apr 26.
Coronary microvascular dysfunction (CMD) is common in patients with and without obstructive epicardial coronary artery disease (CAD). Risk factors for the development of CMD have not been fully elucidated, and data regarding sex-associated differences in traditional cardiovascular risk factors for obstructive CAD in patients with CMD are lacking.
In this single-center, prospective registry, we enrolled patients with nonobstructive CAD undergoing clinically indicated invasive assessment of coronary microvascular function between November 2019 and March 2023. Associations between coronary microvascular dysfunction, traditional cardiovascular risk factors, and sex were assessed using univariate and multivariate regression models.
Overall, 245 patients with nonobstructive CAD were included in the analysis (62.9% female; median age 68 (interquartile range: 59, 75). Microvascular dysfunction was diagnosed in 141 patients (57.5%). The prevalence of microvascular dysfunction was similar in women and men (59.0% vs. 57.0%; p = 0.77). No association was found between traditional risk factors for coronary atherosclerosis and CMD regardless of whether CMD was structural or functional. In women, but not in men, older age and the presence of previous ischemic heart disease were associated with lower coronary flow reserve (β = -0.29; p < 0.01 and β = -0.15; p = 0.05, respectively) and lower resistive reserve ratio (β = -0.28; p < 0.01 and β = -0.17; p = 0.04, respectively).
For the entire population, no association was found between coronary microvascular dysfunction and traditional risk factors for coronary atherosclerosis. In women only, older age and previous ischemic heart disease were associated with coronary microvascular dysfunction. Larger studies are needed to elucidate risk factors for CMD.
冠状动脉微血管功能障碍（CMD）在有和没有阻塞性心外膜冠状动脉疾病（CAD）的患者中都很常见。CMD发生的危险因素尚未完全阐明，并且缺乏关于CMD患者中阻塞性CAD的传统心血管危险因素的性别差异数据。
在这个单中心前瞻性登记研究中，我们纳入了2019年11月至2023年3月期间接受临床指征的冠状动脉微血管功能侵入性评估的非阻塞性CAD患者。使用单变量和多变量回归模型评估冠状动脉微血管功能障碍、传统心血管危险因素和性别之间的关联。
总体而言，245例非阻塞性CAD患者纳入分析（女性占62.9%；中位年龄68岁（四分位间距：59，75））。141例患者（57.5%）被诊断为微血管功能障碍。微血管功能障碍在女性和男性中的患病率相似（59.0%对57.0%；p = 0.77）。无论CMD是结构性还是功能性的，均未发现冠状动脉粥样硬化的传统危险因素与CMD之间存在关联。在女性中，而非男性中，年龄较大和既往有缺血性心脏病与较低的冠状动脉血流储备（β = -0.29；p < 0.01和β = -0.15；p = 0.05）以及较低的阻力储备率（β = -0.28；p < 0.01和β = -0.17；p = 0.04）相关。
对于整个人群，未发现冠状动脉微血管功能障碍与冠状动脉粥样硬化的传统危险因素之间存在关联。仅在女性中，年龄较大和既往有缺血性心脏病与冠状动脉微血管功能障碍相关。需要更大规模的研究来阐明CMD的危险因素。
