在心力衰竭患者中冠状动脉微血管功能障碍:HFrEF与HFpEF模式的表征
Pasquale Paolisso1,2, Emanuele Gallinoro1,3, Marta Belmonte1,2
1Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.).
Circulation. Heart failure
|December 18, 2023
概括
冠状动脉微血管功能障碍 (CMD) 影响心力衰竭 (HF) 的进展. 侵入性评估揭示了保留喷射分数的HF和减少喷射分数 (HFrEF) 的HF中明显的CMD模式,预测了HFrEF的反向重塑.
科学领域:
- 心脏病学 心脏病学
- 心血管研究研究心血管研究
- 心脏衰竭病理生理学 病理生理学
背景情况:
- 冠状动脉微血管功能障碍 (CMD) 是心力衰竭 (HF) 发展和恶化的关键因素.
- 慢性冠状动脉疾病会影响HF,不管是射出分数还是阻塞性冠状动脉疾病.
- 对CMD的侵入性评估为HF表型和患者预后提供了有价值的见解.
研究的目的:
- 在HF患者中侵入性评估冠状动脉流量,微血管阻力,心肌 perfusion 和储量.
- 为了区分CMD模式的高频与保留喷射率 (HFpEF) 和低射率 (HFrEF) 的高频.
主要方法:
- 一项针对56名高压患者 (21名HFpEF,35名HFrEF) 的前性研究,这些患者患有非阻塞性冠状动脉疾病.
- 使用连续的冠状动脉内热稀释进行CMD的侵入性评估,将CMD定义为冠状动脉流量储备<2.5.5.
- 通过心声学,CT血管学和冠状动脉流量测量量心肌质量的量化和心肌 perfusion 的计算.
主要成果:
- 与HFpEF患者相比,HFrEF患者的心肌质量显著增加.
- 总体而言,52%的患者表现出CMD,在HF表型中患病率相似.
- 在HFrEF中,CMD呈现为功能性 (低电阻,静止时高流量);在HFpEF中,它是结构性的 (高电阻,高血压时低流量).
- 在HFrEF中,CMD独立预测了左心室逆向重塑的减少.
结论:
- 连续的冠心内热稀释有效地定义和表征高频中不同的CMD模式.
- 这种方法可以识别具有较高风险的左心室逆转型改造损伤的HFrEF患者.
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