Reduced Microvascular Blood Volume as a Driver of Coronary Microvascular Disease in Patients With Non-obstructive Coronary Artery Disease: Rationale and Design of the MICORDIS Study.
Reduced Microvascular Blood Volume as a Driver of Coronary Microvascular Disease in Patients With Non-obstructive Coronary Artery Disease: Rationale and Design of the MICORDIS Study.
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DOI：
10.3389/fcvm.2021.730810
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发表时间：
2021
影响因子：
3.6
通讯作者：
Appelman Y
中科院分区：
文献类型：
--
作者：
Vink CEM;van de Hoef TP;Götte MJW;Eringa EC;Appelman Y
背景：非阻塞性冠状动脉缺血（INOCA）是缺血性心脏病谱系的一部分，尤其常见于女性。 INOCA具有多种机制，例如冠状血管痉挛和冠状微血管功能障碍（CMD）。冠状动脉血流储备 (CFR) 减少和/或心肌阻力 (MR) 增加通常用于诊断 CMD。然而，CFR 和 MR 并不能描述 CMD 的所有病理生理机制。心肌耗氧量 (MVO2) 增加通常会增加心肌血容量 (MBV)，与心肌血流量 (MBF) 无关。此外，胰岛素还能增强健康骨骼肌的 MBV，但这种作用在糖尿病和肥胖等 INOCA 相关疾病中会受到损害。因此，我们建议减少 INOCA 患者的 MBV。目的：评估 INOCA 患者在基线、高胰岛素血症和应激期间心肌血容量 (MBV) 是否减少。设计：MICORDIS 研究是一项单中心观察性横断面队列研究（标识符 NTR7515）。主要结局是 INOCA 患者和匹配的健康对照之间的 MBV。患者组将使用多普勒导丝、冠状动脉内腺苷和乙酰胆碱进行冠状动脉功能测试，以测量 CFR 和冠状血管痉挛。患者和对照组都将接受心肌造影超声心动图 (MCE)，以确定基线、高胰岛素血症期间和应激期间的 MBV。随后，心脏磁共振 (CMR) 将作为 INOCA 患者 CMD 的新型无创诊断工具进行评估。微血管内皮功能是 MBV 的决定因素，将通过使用 EndoPAT 的无创微血管功能测试和测量循环内皮细胞 (ECFC) 中 NO 的产生来进行评估。
Background: Ischemia with non-obstructive coronary arteries (INOCA) is part of the ischemic heart disease spectrum, and is particularly observed in women. INOCA has various mechanisms, such as coronary vasospasm and coronary microvascular dysfunction (CMD). A decreased coronary flow reserve (CFR) and-or increased myocardial resistance (MR) are commonly used to diagnose CMD. However, CFR and MR do not describe all pathophysiological mechanisms underlying CMD. Increased myocardial oxygen consumption (MVO2) normally increases myocardial blood volume (MBV), independently from myocardial blood flow (MBF). In addition insulin enhances MBV in healthy skeletal muscle, and this effect is impaired in INOCA-related conditions such as diabetes and obesity. Therefore, we propose that MBV is reduced in INOCA patients. Aim: To assess whether myocardial blood volume (MBV) is decreased in INOCA patients, at baseline, during hyperinsulinemia and during stress. Design: The MICORDIS-study is a single-center observational cross-sectional cohort study (identifier NTR7515). The primary outcome is MBV, compared between INOCA patients and matched healthy controls. The patient group will undergo coronary function testing using a Doppler guidewire, intracoronary adenosine and acetylcholine to measure CFR and coronary vasospasm. Both the patient- and the control group will undergo myocardial contrast echocardiography (MCE) to determine MBV at baseline, during hyperinsulinemia and during stress. Subsequently, cardiac magnetic resonance (CMR) will be evaluated as a new and noninvasive diagnostic tool for CMD in INOCA patients. Microvascular endothelial function is a determinant of MBV and will be evaluated by non-invasive microvascular function testing using EndoPAT and by measuring NO production in circulating endothelial cells (ECFCs).
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DOI：
10.1161/atvbaha.108.169722
发表时间：
2008-11
期刊：
Arteriosclerosis, thrombosis, and vascular biology
影响因子：
--
作者：
Kim F;Pham M;Maloney E;Rizzo NO;Morton GJ;Wisse BE;Kirk EA;Chait A;Schwartz MW
通讯作者：
Schwartz MW
影响因子：
5.6
作者：
Faris P;Negri S;Perna A;Rosti V;Guerra G;Moccia F
通讯作者：
Moccia F
影响因子：
0.7
作者：
Meeme, A.;Buga, G. A. B.;Namugowa, A.
通讯作者：
Namugowa, A.
影响因子：
11.3
作者：
Everaars, Henk;de Waard, Guus A.;van Royen, Niels
通讯作者：
van Royen, Niels
影响因子：
39.3
作者：
Beltrame, John F.;Crea, Filippo;Merz, C. Noel Bairey
通讯作者：
Merz, C. Noel Bairey