冠状动脉微血管功能障碍患者心律失常的患病率
Prevalence of Arrhythmias in Patients With Coronary Microvascular Dysfunction.
作者信息
Chitturi Kalyan R, Kumar Sant, Hill Andrew P, Lorente-Ros Marta, Cellamare Matteo, Merdler Ilan, Abusnina Waiel, Haberman Dan, Lupu Lior, Chaturvedi Abhishek, Ozturk Sevket Tolga, Cermak Vijoli, Sawant Vaishnavi, Zhang Cheng, Ben-Dor Itsik, Tsimploulis Apostolos, Waksman Ron, Hashim Hayder D, Case Brian C
机构信息
Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA.
Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.
出版信息
Catheter Cardiovasc Interv. 2025 Feb;105(2):483-490. doi: 10.1002/ccd.31324. Epub 2024 Dec 11.
BACKGROUND
Coronary microvascular dysfunction (CMD) is an important cause of angina with nonobstructive coronary arteries (ANOCA). It is unclear whether CMD is associated with arrhythmia.
AIMS
This study aimed to evaluate the prevalence of arrhythmias in patients with ANOCA and CMD compared to those in patients with ANOCA without CMD.
METHODS
In this observational study of the Coronary Microvascular Disease Registry (NCT05960474), patients with ANOCA who underwent invasive coronary functional assessment for CMD were included. The diagnosis of arrhythmia was based on 12-lead electrocardiography (ECG), or clinical diagnosis accompanied by ECG evidence within 1 year before CMD evaluation.
RESULTS
The study included 262 patients; 66 (25.2%) were CMD-positive. Patients with CMD were older, and there was no difference in history of heart failure and baseline left ventricular ejection fraction compared to those without CMD. Premature atrial contractions (PACs) (25.8% vs. 5.6%; p < 0.001), supraventricular tachycardia (SVT) (24.2% vs. 6.6%; p < 0.001), premature ventricular complexes (PVCs) (43.9% vs. 10.7%; p < 0.001), nonsustained ventricular tachycardia (NSVT) (28.8% vs. 3.1%; p < 0.001), and accelerated idioventricular rhythm (9.1% vs. 2.6%; = 0.02) were more common in CMD-positive patients. In a multivariate analysis adjusting for baseline differences and other variables clinically associated with arrhythmia, CMD was associated with PACs (odds ratio [OR]: 4.7; 95% confidence interval [CI]: 1.8-11.9), SVT (OR: 3.5; 95% CI: 1.5-8.6), PVCs (OR: 5.9; 95% CI: 2.6-13.0), and NSVT (OR: 9.5; 95% CI: 3.2-27.7).
CONCLUSION
Patients with ANOCA and CMD have a higher likelihood of arrhythmias, especially ventricular arrhythmias.
背景
冠状动脉微血管功能障碍（CMD）是无阻塞性冠状动脉（ANOCA）性心绞痛的重要病因。CMD是否与心律失常相关尚不清楚。
目的
本研究旨在评估ANOCA合并CMD患者与无CMD的ANOCA患者心律失常的患病率。
方法
在这项冠状动脉微血管疾病注册研究（NCT05960474）的观察性研究中，纳入了因CMD接受有创冠状动脉功能评估的ANOCA患者。心律失常的诊断基于12导联心电图（ECG），或在CMD评估前1年内伴有ECG证据的临床诊断。
结果
该研究纳入了262例患者；66例（25.2%）CMD呈阳性。CMD阳性患者年龄较大，与无CMD患者相比，心力衰竭病史和基线左心室射血分数无差异。房性早搏（PACs）（25.8%对5.6%；p<0.001）、室上性心动过速（SVT）（24.2%对6.6%；p<0.001）、室性早搏（PVCs）（43.9%对10.7%；p<0.001）、非持续性室性心动过速（NSVT）（28.8%对3.1%；p<0.001）和加速性室性自主心律（9.1%对2.6%；p=0.02）在CMD阳性患者中更常见。在对基线差异和其他与心律失常临床相关的变量进行调整的多变量分析中，CMD与PACs（比值比[OR]：4.7；95%置信区间[CI]：1.8-11.9）、SVT（OR：3.5；95%CI：1.5-8.6）、PVCs（OR：5.9；95%CI：2.6-13.0）和NSVT（OR：9.5；95%CI：3.2-27.7）相关。
结论
ANOCA合并CMD患者发生心律失常的可能性更高，尤其是室性心律失常。
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