Prognostic Links Between OCT-Delineated Coronary Morphologies and Coronary Functional Abnormalities in Patients With INOCA
Prognostic Links Between OCT-Delineated Coronary Morphologies and Coronary Functional Abnormalities in Patients With INOCA
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DOI：
10.1016/j.jcin.2020.12.025
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发表时间：
2021-03-15
影响因子：
11.3
通讯作者：
Shimokawa, Hiroaki
中科院分区：
文献类型：
--
作者：
Nishimiya, Kensuke;Suda, Akira;Shimokawa, Hiroaki
目的探讨缺血和非阻塞性冠状动脉疾病（INOCA）患者冠状动脉形态与冠状动脉功能异常之间是否存在预后联系。背景：尽管INOCA引起了广泛的关注，但对冠状动脉形态学对这种疾病的预后影响知之甚少。方法连续纳入329例INOCA患者，采用痉挛激发试验联合乳酸取样诊断心外膜和微血管痉挛（MVS）。根据功能检查将患者分为4组：无心外膜痉挛或MVS的对照组（n = 32）、单纯MVS组（n = 51）、2个冠状动脉段弥漫性痉挛组（n = 204）和1个冠状动脉段局灶性痉挛组（n = 42）。在这个人群中，进行了左冠状动脉前降支光学相干断层成像，以评估血管外血管（AVV）和斑块内新生血管（IPN）。同时测定了微循环阻力指数。结果MVS多伴有弥漫性痉挛（70%）和局灶性痉挛（68%），AVV与微循环阻力指数有良好的相关性（R = 0.353; p = 0.022）。中位随访1043天，局灶性痉挛预后最差（log rank p = 0.005），其中IPN是一个重要的预后因素。相反，弥漫性痉挛表现出最大的AVV，预后中等。在生理指标中加入AVV和IPN可显著增强INOCA的预后价值（曲线下面积= 0.88 vs. 0.76; p = 0.048）。结论：这些结果首次证明了冠状动脉形态（通过光学相干断层扫描评估）和冠状动脉功能异常之间存在重要的预后联系，表明这两种评估在这一人群中的重要性。[J] .中国医学杂志2021；14:606。18) ?2021年作者。由爱思唯尔代表美国心脏病学会基金会出版。这是一篇基于CC BY-NC-ND许可（http://creativecommons.org/licenses/by-nc-nd/4.0/）的开放获取文章。
OBJECTIVES Whether there are prognostic links between coronary morphologies and coronary functional abnormal-ities was examined in ischemia and nonobstructive coronary artery disease (INOCA) patients. BACKGROUND Although INOCA has attracted much attention, little is known about the prognostic impact of coronary morphologies in this disorder. METHODS A total of 329 consecutive INOCA patients were enrolled and underwent spasm provocation testing com-bined with lactate sampling for diagnosis of epicardial and microvascular spasm (MVS). On the basis of the functional tests, the patients were classified into 4 groups: a control group without epicardial spasm or MVS (n = 32), MVS alone (n = 51), diffuse spasm in $2 coronary segments (n = 204), and focal spasm in 1 segment (n = 42). In this population, optical coherence tomography imaging of the left anterior descending coronary artery was performed for evaluation of adventitial vasa vasorum (AVV) and intraplaque neovessels (IPN). Index of microcirculatory resistance was also measured. RESULTS MVS frequently coexisted with diffuse (70%) and focal spasm (68%) with a good correlation between AVV and index of microcirculatory resistance (R = 0.353; p = 0.022). For a median follow-up of 1,043 days, focal spasm showed the worst prognosis (log rank p = 0.005), for which IPN was a significant prognostic factor. By contrast, diffuse spasm showed the greatest AVV with an intermediate prognosis. The prognostic value of INOCA was significantly enhanced by adding AVV and IPN to the physiological indices (area under the curve = 0.88 vs. 0.76; p = 0.048). CONCLUSIONS These results provide the first evidence that there are important prognostic links between coronary morphologies (evaluated by optical coherence tomography) and coronary functional abnormalities in patients with INOCA, indicating the importance of both evaluations in this population. (J Am Coll Cardiol Intv 2021;14:606?18) ? 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).