Heterogeneity of microvascular dysfunction in women with chest pain not attributable to coronary artery disease: Implications for clinical practice
Heterogeneity of microvascular dysfunction in women with chest pain not attributable to coronary artery disease: Implications for clinical practice
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DOI：
10.1067/mhj.2003.95
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发表时间：
2003-04-01
影响因子：
4.8
通讯作者：
Reis, SE
中科院分区：
文献类型：
--
作者：
Marroquin, OC;Holubkov, R;Reis, SE
研究背景无梗阻性冠状动脉疾病(CAD)的胸痛患者常伴有冠状动脉微血管功能障碍和诱发性心肌缺血。微血管功能障碍通常是通过在冠状动脉造影术中显示单个冠状动脉的异常血流储备来诊断的。因此，诊断的准确性取决于心肌微血管功能障碍的一致性。方法在女性缺血综合征评估(WISE)中，34名胸痛且无明显冠心病的女性和9名女性对照受试者接受了N-13-NH3正电子发射断层扫描，以测量腺苷引起的心肌血流灌注的变化(即冠脉血流储备[CFR])。结果左前降支(LAD)、回旋支(LCx)和右冠状动脉(RCA)的平均CFR分别为2.85+/-1.35、2.58+/-0.94和3.24+/-1.42。微血管功能正常(CFR大于或等于2.5)与异常的符合率分别为71.8%、66.7%和61.6%。左前降支与右冠状动脉(r=0.79，P<0.01)、左前降支与左前降支(r=0.79，P<0.01)之间存在中等程度的相关。0.61，P<；.001)，以及Lcx和RCA(r=0.57，P<；.001)。同时比较3支冠状动脉的CFR，发现Lcx值明显低于RCA和LAD分布。结论有胸痛且无冠脉病变的女性冠脉分布与微血管功能分级有很大的不一致性，提示微血管功能障碍在心肌中呈异质性分布。在心导管术中评估单个冠状动脉的CFR可能不能准确地评估非冠心病引起的胸痛患者的冠脉微循环。
Background Women with chest pain in the absence of obstructive coronary artery disease (CAD) frequently have coronary microvascular dysfunction and inducible myocardial ischemia. Microvascular dysfunction is commonly diagnosed by demonstrating abnormal flow reserve in a single coronary artery during angiography. Therefore, diagnostic accuracy is dependent on homogeneity of microvascular dysfunction in the myocardium.Methods In the Women's Ischemia Syndrome Evaluation (WISE) 34 women with chest pain and no significant CAD and 9 female control subjects underwent N-13-NH3 positron emission tomography to measure adenosine-induced changes in myocardial perfusion (ie, coronary flow reserve [CFR]). Flow reserve was correlated among the left anterior descending (LAD), circumflex (LCx), and right (RCA) coronary artery distributions.Results The mean CFR in the LAD, LCx, and RCA was 2.85 +/- 1.35, 2.58 +/- 0.94, and 3.24 +/- 1.42, respectively. Concordance in the classification of microvascular function as normal (CFR greater than or equal to2.5) versus abnormal was present in the LAD and RCA, LAD and LCx, and, RCA and LCx distributions in only 71.8%, 66.7%, and 61.6% of patients, respectively. There was a modest degree of correlation of CFR between the LAD and RCA (r = 0.79, P < .001), LAD and LCx (r =. 0.61, P < .001), and LCx and RCA (r = 0.57, P < .001). Comparison of CFR in the 3 coronary arteries simultaneously in all patients demonstrated that the LCx had values that were significantly lower than the RCA and LAD distributions.Conclusion Substantial discordance of classification of microvascular function among coronary artery distributions in women with chest pain and no CAD suggests that microvascular dysfunction is distributed heterogeneously in the myocardium. Assessment of CFR in a single coronary artery during cardiac catheterization may not provide an accurate assessment of the coronary microcirculation in women with chest pain not attributable to CAD.