冠動脈微小血管機能不全は運動中に心筋不全と異常冠動脈 perfusion と関連している

Haseeb Rahman¹, Matthew Ryan¹, Matthew Lumley¹

¹From The British Heart Foundation Centre of Research Excellence, Schools of Cardiovascular Medicine & Sciences (H.R., M.R., M.L., B.M., H.M., H.E., B.C., M.M., A.W., D.P.), King's College London, United Kingdom.

Circulation

|November 12, 2019

まとめ

胸痛患者の冠動脈の流れの減少は,誘導性不血症と異常な運動反応を示しています. マイクロ血管機能障害 (MVD) の2つのタイプは,運動に対する異なる血管反応を示し,さらなる研究が必要である.

科学分野:

心臓病科
血管の生理学
診断用イメージング

背景:

冠動脈微小血管機能不全 (MVD) は,非阻害冠動脈の血流障害を伴う.
MVD,運動生理学,誘導性不血症との関係は不明である.

研究の目的:

冠動脈血管拡張反応の低下と異常な運動生理学または誘導性心筋動脈不全の間の相関を調べる.
生理学的反応に基づいて機能的および構造的MVDを区別する.

主な方法:

休息,運動,高血圧の同時測定
微小血管抵抗 (MR) と冠動脈 perfusion 効率の計算
心臓のMRIを用いた心筋血流と心下内静脈の輸血比の定量化

主要な成果:

MVD (冠動脈フロー・リザーブ < 2. 5) の患者は,対照群と比較して,誘導性不血症 (82%) の割合が著しく高かった.
MVD患者では,対照群とは異なり,ストレス中に輸血効率が低下した.
2つのMVDエンドタイプが特定されました: 機能的MVDと正常な高血圧 MRと構造的MVDと高血圧 MRです.

結論:

冠動脈の流れの減少は,非阻害性冠動脈疾患における誘導性不血症と適応不良の運動反応と関連しています.
2つの異なるMVDエンドタイプと異なる運動血管反応が特定されました.
これらのMVDの内型に対する予後的な影響と最適な治療法を決定するには,さらなる研究が必要です.

キーワード:

冠動脈疾患運動する微小血管性アンギナペルフュージョン画像

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