冠状动脉血管功能障碍与非阻塞性冠状动脉疾病患者的心血管事件有关
Yoshihisa Kanaji1, Ali Ahmad2, Jaskanwal Deep Singh Sara2
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA; Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
JACC. Cardiovascular interventions
|February 28, 2024
概括
冠状动脉功能障碍 (CVDys) 现型与心痛和非阻塞性冠状动脉疾病 (ANOCA) 患者的治疗结果更差有关. 无论是内皮依赖的还是独立的微血管功能障碍都能预测心脏不良事件.
科学领域:
- 心脏病学 心脏病学
- 血管生物学 血管生物学
- 临床医学 临床医学
背景情况:
- 冠状动脉动脉功能障碍 (CVDys) 是一种复杂的疾病,影响冠状动脉功能.
- 根据解剖学和功能机制对CVDys进行分类对于理解其影响至关重要.
- 患有胸痛和非阻塞性冠状动脉疾病 (ANOCA) 的患者往往会面临诊断方面的挑战.
研究的目的:
- 研究不同CVDys表型与ANOCA患者的临床结果之间的关联.
- 为了确定不同类型的冠状动脉内皮和非内皮功能障碍的预后值.
- 识别特定的CVDys模式,预测主要的不良心脏和脑血管事件.
主要方法:
- 使用冠状动脉内多普勒导线对1196名ANOCA患者进行冠状动脉反应性测试.
- 评估内皮依赖和独立的微血管和上心冠状动脉功能.
- 根据冠状动脉血流量,直径变化,冠状动脉流量储备以及对乙胆和酸甘的反应来定义功能障碍.
- 对主要不良心脏和脑血管事件 (MACE) 的随访时间平均为6.3年.
主要成果:
- CVDys的患病率各不相同:51.8%的内皮依赖微血管功能障碍,24.5%的内皮依赖微血管功能障碍,47.4%的内皮依赖心上冠状动脉功能障碍,25.4%的内皮依赖心上冠状动脉功能障碍.
- 患有内皮依赖微血管功能障碍 (19.5%),内皮依赖心上冠状动脉功能障碍 (19.7%) 或内皮独立微血管功能障碍 (22.2%) 的患者与没有内皮的患者相比,MACE的发生率显著更高.
- 降低冠状动脉流量储备和受损的内皮依赖于乙胆的微血管反应是MACE的独立预测因素.
结论:
- 特定的CVDys表型与ANOCA患者的不良结果有差异性关联.
- 内皮依赖和内皮独立的微血管功能提供独立的预后信息.
- 针对和理解这些特定的功能缺陷可能会改善ANOCA中的风险分层和风险管理.
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