在INOCA患者的冠状动脉微循环疾病评估中,血管学衍生IMR的诊断性能
Marta Diachyshyn1,2,3, Łukasz Niewiara1,2, Piotr Szolc4,2
1Department of Interventional Cardiology, Jagiellonian University Medical College, Institute of Cardiology, Saint John Paul II Hospital, Krakow, Poland.
Cardiology journal
|November 25, 2025
概括
基于血管造影的微循环阻力指数 (IMRangio) 显示,在患有缺血并没有阻塞性冠状动脉 (INOCA) 的患者中,与侵入性测量有显著的相关性. 为提高检测冠状动脉微循环功能障碍 (CMD) 的特异性,建议使用更高的切断值.
科学领域:
- 心脏病学 心脏病学
- 医疗成像医学成像
- 计算流体动力学的流体动力学.
背景情况:
- 冠状动脉微循环功能障碍 (CMD) 的基于线路的诊断风险在缺血症和没有阻塞性冠状动脉 (INOCA) 患者中是无计划的再血管化.
- 基于血管造影的非侵入性方法,如基于血管造影的微循环阻力指数 (IMRangio),正在出现以减轻这些风险.
- IMRangio使用计算流体动力学 (CFD) 与血管学和大动脉压力来估计微循环阻力指数 (IMR).
研究的目的:
- 评估非侵入性IMRangio和基于热稀释的侵入性IMR之间的相关性.
- 评估IMRangio在MOSAIC-COR注册表队列中识别CMD的诊断性能.
主要方法:
- 来自MOSAIC-COR注册表的74名INOCA患者 (92名冠心病患者) 的数据分析.
- 冠状动脉生理评估侵入性使用热敏电阻线热稀释和乙胆测试.
- 对血管图进行后期计算流体动力学 (CFD) 分析,以获得IMRangio值.
主要成果:
- 在IMRangio和侵入性IMR之间发现了显著的相关性 (斯皮尔曼rho 0.29,p < 0.001).
- 中位数IMRangio为29 (Q1-Q3: 22-46),相比之下,入侵性IMR的中位数为17 (Q1-Q3: 13-26).
- 一个IMRangio切线>46.5U显示38%的灵敏度和82%的特异性预测IMR>25,表明CMD.
结论:
- 在INOCA患者中,IMRangio与侵入性测量IMR显著相关.
- 电流切断可能需要调整,以提高CMD检测的特异性.
- 基于血管造影的评估为评估冠状动脉微循环提供了一个有希望的非侵入性方法.
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