心绞痛与非阻塞性冠状动脉的功能评估：从微血管阻力储备到冠状动脉微血管功能障碍的亚型

Functional assessment in angina and non-obstructive coronary arteries: from microvascular resistance reserve to subtypes of coronary microvascular dysfunction.

作者信息

Galante Domenico, Viceré Andrea, Pollio Benvenuto Ciro, Viccaro Vincenzo, Giuliana Chiara, Todisco Simona, Capalbo Gennaro, Montone Rocco, Romagnoli Enrico, Aurigemma Cristina, Trani Carlo, Burzotta Francesco, Crea Filippo, Leone Antonio Maria

机构信息

Center of Excellence in Cardiovascular Sciences, Ospedale Isola Tiberina, Gemelli Isola.

Department of Cardiovascular and Pneumological Sciences, Università Cattolica del Sacro Cuore.

出版信息

J Cardiovasc Med (Hagerstown). 2025 Feb 1;26(2):72-80. doi: 10.2459/JCM.0000000000001689. Epub 2024 Dec 17.

DOI:10.2459/JCM.0000000000001689

PMID:39841912

Abstract

AIMS

Coronary microvascular dysfunction (CMD) is a heterogeneous condition defined by reduced coronary flow reserve (CFR). The new index 'microvascular resistance reserve' (MRR) has been developed, but its role is unclear. We investigate the relationships between functional indices in ANOCA (angina and non-obstructive coronary arteries) patients and evaluate the hemodynamic features of different CMD subtypes.

METHODS

We enrolled consecutive ANOCA patients assessed by using the bolus thermodilution technique. CFR, index of microcirculatory resistance (IMR) and MRR were estimated and correlated with each other. Patients were divided into two groups based on CMD presence (CFR < 2.5). Subsequently, high-hyperaemic-resistance (HHR) and low-hyperaemic-resistance (LHR) CMD subtypes were defined according to IMR values (cut-off 25). Microvascular flow and resistance were estimated both at rest and during hyperaemia with Tmnrest/IMRrest and Tmnhyp/IMR, respectively. All functional indices were compared between groups.

RESULTS

In total, 108 patients were enrolled: 66 patients in the normal group (CFR ≥ 2.5), 20 in the HHR-CMD group (CFR < 2.5 and IMR ≥ 25) and 22 in the LHR-CMD group (CFR < 2.5 and IMR < 25). MRR strongly correlated (r = 0.968, P < 0.01) with CFR, showing a good discriminatory power (area under the curve = 0.97) and accuracy (85%) for detecting CMD. LHR-CMD patients showed reduced microvascular resistance (IMRrest 34.3 ± 15.1, P < 0.01) and increased resting flow (Tmnrest 0.37 ± 0.17, P < 0.01), while HHR-CMD patients had impaired hyperaemic flow (Tmnhyp 0.45 ± 0.24 P < 0.01). MRR was reduced in CMD patients (P < 0.01), with no differences between CMD subtypes (P = 0.66).

CONCLUSIONS

In ANOCA patients, MRR and CFR are strongly correlated and could be considered as functionally interchangeable tools. IMR is crucial for differentiating CMD endotypes.

摘要

目的

冠状动脉微血管功能障碍（CMD）是一种由冠状动脉血流储备（CFR）降低所定义的异质性疾病。新指标“微血管阻力储备”（MRR）已被提出，但其作用尚不清楚。我们研究了无阻塞性冠状动脉伴心绞痛（ANOCA）患者功能指标之间的关系，并评估了不同CMD亚型的血流动力学特征。

方法

我们纳入了连续的使用团注热稀释技术评估的ANOCA患者。估计CFR、微循环阻力指数（IMR）和MRR，并相互关联。根据CMD的存在情况（CFR<2.5）将患者分为两组。随后，根据IMR值（临界值25）定义高充血阻力（HHR）和低充血阻力（LHR）CMD亚型。分别用静息状态下的Tmnrest/IMRrest和充血状态下的Tmnhyp/IMR来估计微血管血流和阻力。比较两组之间的所有功能指标。

结果

总共纳入了108例患者：正常组66例（CFR≥2.5），HHR-CMD组20例（CFR<2.5且IMR≥25），LHR-CMD组22例（CFR<2.5且IMR<25）。MRR与CFR高度相关（r=0.968，P<0.01），在检测CMD方面显示出良好的鉴别能力（曲线下面积=0.97）和准确性（85%）。LHR-CMD患者表现出微血管阻力降低（静息IMR 34.3±15.1，P<0.01）和静息血流增加（静息Tmn 0.37±0.17，P<0.01），而HHR-CMD患者充血血流受损（充血状态下Tmnhyp 0.45±0.24，P<0.01）。CMD患者的MRR降低（P<0.01），CMD亚型之间无差异（P=0.66）。