Risk Stratification of Patients With NonObstructive Coronary Artery Disease Using Resistive Reserve Ratio.
Risk Stratification of Patients With NonObstructive Coronary Artery Disease Using Resistive Reserve Ratio.
复制标题
应用阻力储备比对非阻塞性冠状动脉疾病患者进行危险分层。
DOI：
10.1161/jaha.120.020464
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发表时间：
2021-06
影响因子：
5.4
通讯作者：
Lerman A
中科院分区：
文献类型：
--
作者：
Toya T;Ahmad A;Corban MT;Ӧzcan I;Sara JD;Sebaali F;Escaned J;Lerman LO;Lerman A
阻力储备率（RRR），或基线与充血微血管阻力的比值，对预测阻塞性冠状动脉疾病患者的临床结局具有预后意义。然而，其在心绞痛或缺血伴非阻塞性冠状动脉疾病患者中的价值尚不清楚。我们纳入了1692例接受有创冠状动脉血管反应性试验的非阻塞性冠状动脉疾病患者。异常冠状动脉血流储备（CFR，充血和基线静息流速的比值）和RRR分别定义为<2.5和<2.62。病死率在CFR异常的患者中略高（428例患者[25%]）（38 [9%]对81 [6%]; P=0.08），并且在RR异常的患者中显著更高在中位随访11.3年期间，RR正常的患者（716例患者[42%]）多于RR正常的患者（70例[10%] vs 49例[5%]，P=0.0002）。CFR异常患者的生存率略低于CFR正常患者（对数秩P=0.08）。相反，RRR异常患者的生存率显著低于RRR正常患者（log-rank P=0.001）。即使在调整其他协变量后，异常RRR与死亡时间缩短相关（调整后风险比，1.63; 95%CI，1.11-2.38; P=0.01）。在无阻塞性冠状动脉疾病的患者中，在预测长期生存率方面，RRR优于CFR上级。RR <2.62与非阻塞性冠状动脉疾病患者死亡风险增加1.6倍相关。包括流量和压力衍生值的冠状动脉微循环阻力储备指数可能比CFR等单独的流量指数更忠实地反映潜在的微血管病理。
Resistive reserve ratio (RRR), or the ratio of baseline to hyperemic microvascular resistance, has prognostic implications in predicting clinical outcomes in patients with obstructive coronary artery disease. However, its value in patients with angina or ischemia with nonobstructive coronary artery disease is unknown. We included 1692 patients with nonobstructive coronary artery disease who underwent invasive coronary vasoreactivity testing. Abnormal coronary flow reserve (CFR, the ratio of hyperemic and baseline resting flow velocities) and RRR were defined as <2.5 and <2.62, respectively. The mortality rate was marginally higher in patients with abnormal CFR (428 patients [25%]) than those with normal CFR (38 [9%] versus 81 [6%]; P=0.08), and was significantly higher in patients with abnormal RRR (716 patients [42%]) than those with normal RRR (70 [10%] versus 49 [5%], P=0.0002) over the median follow‐up of 11.3 years. Patients with abnormal CFR had marginally lower survival than those with normal CFR (log‐rank P=0.08). In contrast, patients with abnormal RRR had significantly lower survival than those with normal RRR (log‐rank P=0.001). Abnormal RRR was associated with shorter time to death even after adjustment for other covariates (adjusted hazard ratio, 1.63; 95% CI, 1.11–2.38; P=0.01). In patients with no obstructive coronary artery disease, RRR was superior to CFR in predicting long‐term survival. An RRR <2.62 was associated with 1.6 times increased risk of death in patients with nonobstructive coronary artery disease. Indices of coronary microcirculatory resistive reserve comprising flow‐ and pressure‐derived values may reflect underlying microvascular pathology more faithfully than flow‐alone indices like CFR.