Coronary Microvascular Dysfunction as a Mechanism of Angina in Severe AS Prospective Adenosine-Stress CMR Study
Coronary Microvascular Dysfunction as a Mechanism of Angina in Severe AS Prospective Adenosine-Stress CMR Study
复制标题
DOI：
10.1016/j.jacc.2016.01.013
复制
发表时间：
2016-03-29
影响因子：
24
通讯作者：
Oh, Jae K.
中科院分区：
文献类型：
--
作者：
Ahn, Jong-Hwa;Kim, Sung Mok;Oh, Jae K.
背景无梗阻性冠状动脉病变(CAD)的重度主动脉瓣狭窄(AS)患者的常见症状，但劳力性心绞痛的发病机制尚不清楚。目的本研究旨在通过腺苷负荷心脏磁共振(CMR)成像，证实微血管功能障碍与重度AS患者胸痛的发生有关，心外膜冠状动脉正常的患者。结果重度AS患者心肌灌注储备指数明显低于正常对照组(P<0.001.0 1)，心绞痛组明显低于无症状组(P<0.0 1)，心绞痛组明显低于无症状组(P<0.0 1)。0.001)。在Logistic回归分析中，心绞痛的唯一独立预测因子是Mpri(优势比：0.003；p<；0.001)。确定与MPRI相关的单变量有：舒张压、E/e‘比值、左心室容量和射血分数、心脏指数、有无晚期Gd增强和左心室重量指数(LVMI)。在多因素分析中，LvMI是影响MPRI的最主要因素(标准化系数：-0.428；p<；0.001)。结论在无梗阻性冠状动脉病变的重度AS患者中，心绞痛与冠状动脉微血管功能受损和左室肥厚有关，而腺苷负荷心绞痛的MPRI是半定量的。(C)2016年，由美国心脏病学院基金会提供。
BACKGROUND Although a common symptom in patients with severe aortic stenosis (AS) without obstructive coronary artery disease (CAD), little is known about the pathogenesis of exertional angina.OBJECTIVES This study sought to prove that microvascular dysfunction is responsible for chest pain in patients with severe AS and normal epicardial coronary arteries using adenosine-stress cardiac magnetic resonance (CMR) imaging.METHODS Between June 2012 and April 2015, 117 patients with severe AS without obstructive CAD and 20 normal controls were enrolled prospectively. After exclusions, study patients were divided into 2 groups according to presence of exertional chest pain: an angina group (n = 43) and an asymptomatic group (n = 41), and the semiquantitative myocardial perfusion reserve index (MPRI) was calculated.RESULTS MPRI values were significantly lower in severe AS patients than in normal controls (0.90 +/- 0.31 vs. 1.25 +/- 0.21; p < 0.001), and were much lower in the angina group than the asymptomatic group (0.74 +/- 0.25 vs. 1.08 +/- 0.28; p < 0.001). In logistic regression analysis, the only independent predictor for angina was MPRI (odds ratio: 0.003; p < 0.001). Univariate associations with MPRI were identified for diastolic blood pressure, E/e' ratio, left ventricular volume and ejection fraction, cardiac index, presence of late gadolinium enhancement, and left ventricular mass index (LVMI). In multivariate analysis, LVMI was the strongest contributing factor to MPRI (standardization coefficient: -0.428; p < 0.001).CONCLUSIONS Our results suggest that, in patients with severe AS without obstructive CAD, angina is related to impaired coronary microvascular function along with LV hypertrophy detectable by semiquantitative MPRI using adenosine-stress CMR. (C) 2016 by the American College of Cardiology Foundation.