Noninvasive Microvascular Indices Reveal Peripheral Vascular Abnormalities in Patients With Suspected Coronary Microvascular Dysfunction
Noninvasive Microvascular Indices Reveal Peripheral Vascular Abnormalities in Patients With Suspected Coronary Microvascular Dysfunction
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DOI：
10.1016/j.cjca.2019.12.003
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发表时间：
2020-08-01
影响因子：
6.2
通讯作者：
Edgell, Heather
中科院分区：
文献类型：
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作者：
Nardone, Massimo;Miner, Steven;Edgell, Heather
背景资料：反应性充血外周动脉张力测定和血流介导的扩张是外周血管功能的常用非侵入性测量。然而，它们与冠状动脉循环，特别是冠状动脉微血管功能障碍（CMD）的关系尚不清楚。因此，本研究的目的是比较这些非侵入性测量与冠状动脉微血管功能后，内皮依赖性，内皮依赖性，交感神经介导的药理学hyperemia.Methods：47例疑似CMD患者完成外周和冠状动脉评估。使用EndoPAT 2000装置收集反应性充血指数，而一部分患者（n = 28）使用多普勒超声完成肱动脉血流介导扩张。冠状动脉微血管功能通过静脉注射腺苷（140 mg/kg/min）、多巴酚丁胺（40 mg/kg/min）和冠状动脉内注射乙酰胆碱（100 mg）的阻力和血流反应进行定量。冠状动脉微血管对腺苷和/或乙酰胆碱的反应性异常被用来定义CMD。（无CMD：0.85 ± 0.23 vs CMD：0.61 ± 0.26，P < 0.05）和血流介导的扩张（无CMD：7.2 +/- 2.3 vs CMD：4.8 +/- 3.1; P < 0.05）在CMD患者中减弱。反应性充血指数与多巴酚丁胺的阻力和血流反应相关（分别为rho =-0.44和rho = 0.39; P < 0.05），而血流介导的舒张与腺苷（rho = -0.48; P < 0.05）和乙酰胆碱（rho = -0.66; P < 0.05）的阻力反应相关。最后，反应性充血指数和流量介导的扩张的敏感性分别为80%和69%，特异性分别为71%和93%，用于识别CMD患者。结论：外周血管功能衰减CMD，和非侵入性测量与冠状动脉对药物刺激的反应。
Background: Reactive hyperemia peripheral arterial tonometry and flow-mediated dilation are common noninvasive measures of peripheral vascular function. However, their relationship with the coronary circulation, particularly in coronary microvascular dysfunction (CMD), is unclear. Therefore, the purpose of this study is to compare these noninvasive measurements with coronary microvascular function after endothelial-independent, endothelial-dependent, and sympathetically mediated pharmacologic hyperemia.Methods: Forty-seven patients with suspected CMD completed peripheral and coronary assessments. The reactive hyperemia index was collected using the EndoPAT2000 device, whereas a subset of patients (n = 28) completed brachial artery flow-mediated dilation using duplex ultrasound. Coronary microvascular function was quantified using the resistance and flow responses to intravenous adenosine (140 mg/kg/min), dobutamine (40 mg/kg/min), and intracoronary acetylcholine (100 mg). Abnormal coronary microvascular responses to adenosine and/or acetylcholine were used to define CMD.Results: The reactive hyperemia index (No CMD: 0.85 +/- 0.23 vs CMD: 0.61 +/- 0.26, P < 0.05) and flow-mediated dilation (No CMD: 7.2 +/- 2.3 vs CMD: 4.8 +/- 3.1; P < 0.05) were attenuated in patients with CMD. Whereas the reactive hyperemia index was correlated with the resistance and flow responses to dobutamine (rho -0.44 and rho = 0.39, respectively; P < 0.05), flow-mediated dilation was correlated with the resistance responses to both adenosine (rho = -0.48; P < 0.05) and acetylcholine (rho = -0.66; P < 0.05). Lastly, the reactive hyperemia index and flow-mediated dilation had sensitivities of 80% and 69% and specificities of 71% and 93%, respectively, for identifying patients with CMD.Conclusions: Peripheral vascular function is attenuated in CMD, and noninvasive measurements are associated with coronary responses to pharmaceutical stimulation.