Prognostic value of modified coronary flow capacity by 13N-ammonia myocardial perfusion positron emission tomography in patients without obstructive coronary arteries
Prognostic value of modified coronary flow capacity by 13N-ammonia myocardial perfusion positron emission tomography in patients without obstructive coronary arteries
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DOI：
10.1016/j.jjcc.2021.09.001
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发表时间：
2022-02-01
影响因子：
2.5
通讯作者：
Yamashita, Takehiro
中科院分区：
文献类型：
--
作者：
Miura, Shiro;Naya, Masanao;Yamashita, Takehiro
背景：冠状动脉循环中的血管扩张剂容量是冠心病(CAD)患者重要的诊断和预后指标。我们的目的是阐明冠状动脉微血管功能障碍(CMD)在非梗阻性CAD患者中的发生率，并评估未来心血管事件的风险。CMD定义为Johnson和Gould提出的受损的改良冠状动脉血流量(MCFC)，由N-13-氨心肌灌注正电子发射断层扫描(PET)测量。在407名患者中，137名患者(中位年龄70岁；63名女性)符合条件并获得随访(中位年龄19.8个月)。终点被定义为心血管死亡或主要心血管不良事件(MACE)，如心血管死亡、非致命性心肌梗死、因任何心脏原因而非计划住院以及非计划冠状动脉血运重建。MCFC受损组包括至少一个血管区域轻度至重度局部CFCs减少的患者(n=34)，其余患者(n=103)被归类为保留了mCFC。结果：总共有5例(4%)患者发生心血管死亡和急性心肌梗死。卡普兰-迈耶曲线显示，与保存的MCFC组相比，MCFC受损组的心血管死亡(p=0.004)和急性心肌梗死(p<；0.0001)的无事件存活率显著降低。MFC受损与心血管死亡和急性心肌梗死的发生率独立相关[危险比(HR)，10.7；95%可信区间(CI)，1.0-106.0；p=0.04和HR，9.5；95%CI，2.5-36.2；p<；0.001]。结论：在无冠状动脉梗阻的可疑冠心病患者中，MFC受损的发生率约为25%，并与心血管死亡和急性心肌梗死的风险增加相关。MCFC的概念可以帮助确定哪些患者将受益于特定的治疗或生活方式的改变，以预防未来的MAC，并可以澄清CMD的潜在机制。(C)2021年日本心脏病学院。爱思唯尔有限公司出版。保留所有权利。
Background: Vasodilator capacity of coronary circulation is an important diagnostic and prognostic tool in patients with coronary artery disease (CAD). We aimed to clarify the incidence of coronary microvascular dysfunction (CMD), defined as impaired modified coronary flow capacity (mCFC) proposed by Johnson and Gould and measured by N-13-ammonia myocardial perfusion positron emission tomography (PET), in patients without obstructive CAD and to evaluate the risk of future cardiovascular events.Methods: This retrospective study recruited 407 consecutive CAD-suspected patients who underwent both pharmacological stress/rest N-13-ammonia PET and coronary angiography. Of the 407 patients, 137 patients (median age, 70 years; 63 women) were eligible and followed up (median, 19.8 months). Endpoints were defined as cardiovascular death or major adverse cardiovascular events (MACEs), such as cardiovascular death, nonfatal myocardial infarction, unplanned hospitalization for any cardiac reasons, and unplanned coronary revascularization. The impaired mCFC group included patients with mildly to severely reduced regional CFC in, at least, one vascular territory (n = 34), while the remaining patients (n = 103) were categorized as having preserved mCFC.Results: Overall, cardiovascular death and MACEs occurred in five (4%) patients. The Kaplan-Meier curve showed a significant reduction in event-free survival for cardiovascular death (p = 0.004) and MACEs (p < 0.0001) in the impaired mCFC group, compared to the preserved mCFC group. Impaired mCFC was independently associated with the incidence of both cardiovascular death and MACEs after propensity-score adjustments [hazard ratio (HR), 10.7; 95% confidence interval (CI), 1.0-106.0; p = 0.04 and HR, 9.5; 95% CI, 2.5-36.2; p < 0.001, respectively].Conclusions: In CAD-suspected patients without obstructive coronary arteries, impaired mCFC was observed in approximately 25% and was associated with a higher risk of cardiovascular death and MACEs. The mCFC concept can help identify patients who would benefit from specific therapies or lifestyle modifications to prevent future MACEs and can clarify potential mechanisms of CMD. (C) 2021 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.