Department of Ultrasound, JinHua Municipal Central Hospital, No.365, Renmin East Road, Wucheng District, Jinhua City, 321000, Zhejiang Province, China.
Department of Cardiology, JinHua Municipal Central Hospital, Jinhua, 321000, Zhejiang, China.
BMC Cardiovasc Disord. 2024 Sep 18;24(1):496. doi: 10.1186/s12872-024-04173-7.
CMD refers to the abnormalities of the tiny arteries and capillaries within the coronary artery system, which result in restricted or abnormal blood flow. CMD is an important mechanism involved in ischemic heart disease and secondary heart failure. CMD can explain left ventricular dysfunction and poor prognosis.The European Association of Cardiovascular Imaging recommends the use of MCE for the assessment of myocardial perfusion. Myocardial contrast echocardiography (MCE) is used to evaluate the accuracy of Coronary microvascular dysfunction (CMD) for predicting major adverse cardiac events (MACEs) in patients with heart failure with preserved ejection fraction (HFpEF) at follow-up.
The clinical data of 142 patients diagnosed with HFpEF in our hospital from January 2020 to January 2022 were retrospectively summarized and stratified into 77 cases (> 1) in the CMD group and 65 cases (= 1) in the non-CMD group based on the perfusion score index (PSI) of the 17 segments of the left ventricle examined by the admission MCE, and the perfusion parameters were measured at the same time, including the peak plateau intensity (A value), the curve slope of the curve rise (βvalue) and A × β values. At a median follow-up of 27 months till October 2023, MACEs were recorded mainly including heart failure exacerbation, revascularization, cardiac death, etc. RESULTS: Increasing age, hypertension, diabetes, and coronary artery disease in the CMD group resulted in decreased left ventricular ejection fraction (LVEF), increased plasma NT-B-type natriuretic peptide (BNP) and left ventricular global longitudinal strain (LVGLS), decreased A-values and A × β-values, and an increased incidence of MACEs (P < 0.05). Univariate and multivariate Cox regression analyses showed that LVGLS (HR = 1.714, 95% CI = 1.289-2.279, P < 0.001) and A × β values (HR = 0.636, 95% CI = 0.417 to 0.969, P = 0.035) were independent predictors of MACEs in patients with HFpEF. The receiver operating characteristic curve (ROC) showed that the area under the curve (AUC) of LVGLS combined with A × β value for diagnosis of MACEs was 0.861 (95% CI = 0.761 ~ 0.961, P < 0.001), which was significantly higher than that of LVGLS or A × β value (P < 0.05). The Kaplan-Meier survival curves showed that the cumulative survival rate in CMD group was significantly lower than non-CMD group (logrank χ = 6.626, P = 0.010), with the most significant difference at 20 months of follow-up.
MCE can evaluate CMD semi-quantitatively and quantitatively, LVGLS combined with A × β value has good performance in predicting the risk of developing MACEs in patients with HFpEF at 3 years of follow-up, and CMD can be used as an important non-invasive indicator for assessing clinical prognosis.
CMD 是指冠状动脉系统中小动脉和毛细血管的异常，导致血流受限或异常。CMD 是缺血性心脏病和继发性心力衰竭的重要机制。CMD 可以解释左心室功能障碍和预后不良。欧洲心血管成像协会建议使用 MCE 评估心肌灌注。心肌对比超声心动图（MCE）用于评估冠状动脉微血管功能障碍（CMD）在预测射血分数保留的心力衰竭（HFpEF）患者随访中主要不良心脏事件（MACE）的准确性。
回顾性总结我院 2020 年 1 月至 2022 年 1 月期间诊断为 HFpEF 的 142 例患者的临床资料，根据入院 MCE 检查的左心室 17 节段的灌注评分指数（PSI）将患者分为 CMD 组（77 例（>1）和非 CMD 组（65 例（=1）。同时测量灌注参数，包括峰值平台强度（A 值）、曲线上升斜率（β 值）和 A×β 值。截至 2023 年 10 月，中位随访 27 个月，主要记录 MACE 事件，包括心力衰竭恶化、血运重建、心脏死亡等。
CMD 组年龄较大、高血压、糖尿病和冠状动脉疾病导致左心室射血分数（LVEF）降低，血浆 NT-B 型脑钠肽（BNP）和左心室整体纵向应变（LVGLS）增加，A 值和 A×β 值降低，MACE 发生率增加（P<0.05）。单因素和多因素 Cox 回归分析显示，LVGLS（HR=1.714，95%CI=1.2892.279，P<0.001）和 A×β 值（HR=0.636，95%CI=0.417 至 0.969，P=0.035）是 HFpEF 患者 MACE 的独立预测因子。受试者工作特征曲线（ROC）显示，LVGLS 联合 A×β 值诊断 MACE 的曲线下面积（AUC）为 0.861（95%CI=0.7610.961，P<0.001），明显高于 LVGLS 或 A×β 值（P<0.05）。Kaplan-Meier 生存曲线显示，CMD 组的累积生存率明显低于非 CMD 组（logrank χ=6.626，P=0.010），在随访 20 个月时差异最显著。
MCE 可以半定量和定量评估 CMD，LVGLS 联合 A×β 值在预测 HFpEF 患者 3 年随访期间发生 MACE 的风险方面具有良好的性能，CMD 可作为评估临床预后的重要无创指标。
