Department of Cardiology, University Hospital, Grenoble, 38000, France.
University Grenoble Alpes, INSERM, CHU Grenoble Alpes, LRB, Grenoble, 38000, France.
Cardiovasc Ultrasound. 2024 May 14;22(1):5. doi: 10.1186/s12947-024-00324-0.
Coronary microvascular dysfunction (CMD) refers to structural and functional abnormalities of the coronary microcirculation, which may be diagnosed using invasive coronary physiology. CMD is responsible for impaired diastolic cardiac function. It has recently been suggested that left atrial strain (LASr) represents a highly sensitive tool for detecting cardiac diastolic function abnormalities. Accordingly, the aim of this study was to investigate the relationship between CMD and LASr.
Consecutively enrolled patients with non-obstructed coronary arteries (NOCA) underwent CMD and LASr evaluation by invasive thermodilution and noninvasive echocardiography, respectively.
Forty-two (42) patients were included, out of which 26 presented with CMD. There were no significant differences between CMD-positive and negative patients in terms of clinical and echocardiographic characteristics. LASr was significantly reduced in patients with CMD (24.6% ± 6.1 vs. 30.3 ± 7.8%, p = 0.01). A moderate correlation was observed between coronary flow reserve and LAsr (r = 0.47, p = 0.002). A multivariate logistic regression analysis demonstrated that CMD was independently associated with LASr (OR = 0.88, 95%CI 0.78-0.99.135, p = 0.04). A LASr cut-off of 25.5% enabled an optimal classification of patients with or without CMD.
Patients with NOCA and CMD had a significantly reduced LASr compared with patients without CMD, suggesting the early impairment of diastolic function in these patients.
冠状动脉微血管功能障碍（CMD）是指冠状动脉微循环的结构和功能异常，可通过有创冠状动脉生理学进行诊断。CMD 可导致舒张性心脏功能受损。最近有研究表明，左心房应变（LASr）是检测舒张性心脏功能异常的一种高度敏感的工具。因此，本研究旨在探讨 CMD 与 LASr 之间的关系。
连续入选的非阻塞性冠状动脉（NOCA）患者分别接受有创热稀释法和非侵入性超声心动图评估 CMD 和 LASr。
共纳入 42 例患者，其中 26 例存在 CMD。CMD 阳性和阴性患者在临床和超声心动图特征方面无显著差异。CMD 患者的 LASr 明显降低（24.6%±6.1%比 30.3%±7.8%，p=0.01）。冠状动脉血流储备与 LASr 之间存在中度相关性（r=0.47，p=0.002）。多变量逻辑回归分析表明，CMD 与 LASr 独立相关（OR=0.88，95%CI 0.78-0.99，p=0.04）。LASr 截断值为 25.5%时，可对存在或不存在 CMD 的患者进行最佳分类。
与无 CMD 的患者相比，NOCA 合并 CMD 的患者的 LASr 明显降低，提示这些患者的舒张功能早期受损。
