Royal Prince Alfred Hospital, Sydney, Australia.
Stanford University Medical Center, Stanford, California, USA.
JACC Cardiovasc Interv. 2024 May 13;17(9):1091-1102. doi: 10.1016/j.jcin.2024.03.007.
Invasive CFT is the gold standard for diagnosing coronary vasomotor dysfunction in patients with ANOCA. Most institutions recommend only testing the left coronary circulation. Therefore, it is unknown whether testing multiple coronary territories would increase diagnostic yield.
The aim of this study was to evaluate the diagnostic yield of multivessel, compared with single-vessel, invasive coronary function testing (CFT) in patients with angina and nonobstructive coronary arteries (ANOCA).
Multivessel CFT was systematically performed in patients with suspected ANOCA. Vasoreactivity testing was performed using acetylcholine provocation in the left (20 to 200 μg) and right (20 to 80μg) coronary arteries. A pressure-temperature sensor guidewire was used for coronary physiology assessment in all three epicardial vessels.
This multicenter study included a total of 228 vessels from 80 patients (57.8 ± 11.8 years of age, 60% women). Compared with single-vessel CFT, multivessel testing resulted in more patients diagnosed with coronary vasomotor dysfunction (86.3% vs 68.8%; P = 0.0005), coronary artery spasm (60.0% vs 47.5%; P = 0.004), and CMD (62.5% vs 36.3%; P < 0.001). Coronary artery spasm (n = 48) predominated in the left coronary system (n = 38), though isolated right coronary spasm was noted in 20.8% (n = 10). Coronary microvascular dysfunction (CMD), defined by abnormal index of microcirculatory resistance and/or coronary flow reserve, was present 62.5% of the cohort (n = 50). Among the cohort with CMD, 27 patients (33.8%) had 1-vessel CMD, 15 patients (18.8%) had 2-vessel CMD, and 8 patients (10%) had 3-vessel CMD. CMD was observed at a similar rate in the territories supplied by all 3 major coronary vessels (left anterior descending coronary artery = 36.3%, left circumflex coronary artery = 33.8%, right coronary artery = 31.3%; P = 0.486).
Multivessel CFT resulted in an increased diagnostic yield in patients with ANOCA compared with single-vessel testing. The results of this study suggest that multivessel CFT has a role in the management of patients with ANOCA.
在患有非阻塞性冠状动脉疾病（ANOCA）的患者中，侵入性 CFT 是诊断冠状动脉血管舒缩功能障碍的金标准。大多数机构仅推荐检测左冠状动脉循环。因此，尚不清楚同时检测多个冠状动脉区域是否会提高诊断率。
本研究旨在评估与单支血管相比，多支血管侵入性冠状动脉功能测试（CFT）在心绞痛和非阻塞性冠状动脉（ANOCA）患者中的诊断效果。
对疑似患有ANOCA 的患者进行多支血管 CFT。使用乙酰胆碱在左冠状动脉（20 至 200μg）和右冠状动脉（20 至 80μg）中进行血管反应性测试。所有三支心外膜血管均使用压力-温度传感器导丝进行冠状动脉生理学评估。
这项多中心研究共纳入了 80 名患者的 228 支血管（57.8±11.8 岁，60%为女性）。与单支血管 CFT 相比，多支血管检查可使更多患者被诊断为冠状动脉血管舒缩功能障碍（86.3% vs 68.8%；P=0.0005）、冠状动脉痉挛（60.0% vs 47.5%；P=0.004）和冠状动脉微血管功能障碍（CMD）（62.5% vs 36.3%；P<0.001）。虽然孤立的右冠状动脉痉挛占 20.8%（n=10），但冠状动脉痉挛（n=48）主要发生在左冠状动脉系统（n=38）。定义为微血管阻力指数和/或冠状动脉血流储备异常的冠状动脉微血管功能障碍（CMD）存在于该队列的 62.5%（n=50）。在患有 CMD 的患者中，27 名患者（33.8%）存在 1 支血管 CMD，15 名患者（18.8%）存在 2 支血管 CMD，8 名患者（10%）存在 3 支血管 CMD。所有 3 支主要冠状动脉供血区域的 CMD 发生率相似（左前降支冠状动脉=36.3%，左回旋支冠状动脉=33.8%，右冠状动脉=31.3%；P=0.486）。
与单支血管 CFT 相比，多支血管 CFT 可提高 ANOCA 患者的诊断率。本研究结果表明，多支血管 CFT 在 ANOCA 患者的管理中具有一定作用。
