Vascular Remodeling in Coronary Microvascular Dysfunction.

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging Pub Date : 2024-08-30 DOI:10.1016/j.jcmg.2024.07.018

Carlos Collet, Koshiro Sakai, Takuya Mizukami, Hirofumi Ohashi, Frederic Bouisset, Serena Caglioni, Lieven van Hoe, Emanuele Gallinoro, Dario Tino Bertolone, Sofie Pardaens, Sofie Brouwers, Tatyana Storozhenko, Ruiko Seki, Daniel Munhoz, Atomu Tajima, Dimitri Buytaert, Marc Vanderheyden, Eric Wyffels, Jozef Bartunek, Jeroen Sonck, Bernard De Bruyne

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引用次数: 0

Abstract

Background: Approximately half of the patients with angina and nonobstructive coronary artery disease (ANOCA) have evidence of coronary microvascular dysfunction (CMD).

Objectives: This study aims to characterize patients with ANOCA by measuring their minimal microvascular resistance and to examine the pattern of vascular remodeling associated with these measurements.

Methods: The authors prospectively included patients with ANOCA undergoing continuous thermodilution assessment. Lumen volume and vessel-specific myocardial mass were quantified using coronary computed tomography angiography (CTA). CMD was defined as coronary flow reserve <2.5 and high minimal microvascular resistance as >470 WU.

Results: A total of 153 patients were evaluated; 68 had CMD, and 22 of them showed high microvascular resistance. In patients with CMD, coronary flow reserve was 1.9 ± 0.38 vs 3.2 ± 0.81 in controls (P < 0.001). Lumen volume was significantly correlated with minimal microvascular resistance (r = -0.59 [95% CI: -0.45 to -0.71]; P < 0.001). In patients with CMD and high microvascular resistance, lumen volume was 40% smaller than in controls (512.8 ± 130.3 mm³ vs 853.2 ± 341.2 mm³; P < 0.001). Epicardial lumen volume assessed by coronary CTA was independently associated with minimal microvascular resistance (P < 0.001). The predictive capacity of lumen volume from coronary CTA for detecting high microvascular resistance showed an area under the curve of 0.79 (95% CI: 0.69-0.88).

Conclusions: Patients with CMD and high minimal microvascular resistance have smaller epicardial vessels than those without CMD. Coronary CTA detected high minimal microvascular resistance with very good diagnostic capacity. Coronary CTA could potentially aid in the diagnostic pathway for patients with ANOCA.

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冠状动脉微血管功能障碍的血管重塑

背景：大约一半的心绞痛和非阻塞性冠状动脉疾病（ANOCA）患者有冠状动脉微血管功能障碍（CMD）的证据：大约一半的心绞痛和非阻塞性冠状动脉疾病（ANOCA）患者有冠状动脉微血管功能障碍（CMD）的证据：本研究旨在通过测量非阻塞性冠状动脉疾病患者的最小微血管阻力来描述其特征，并研究与这些测量结果相关的血管重塑模式：作者前瞻性地纳入了接受连续热稀释评估的 ANOCA 患者。使用冠状动脉计算机断层扫描血管造影术（CTA）对管腔容积和血管特异性心肌质量进行量化。CMD定义为冠状动脉血流储备470 WU：共对 153 名患者进行了评估；68 人患有 CMD，其中 22 人表现出高微血管阻力。在 CMD 患者中，冠状动脉血流储备为 1.9 ± 0.38，而对照组为 3.2 ± 0.81（P < 0.001）。管腔容积与最小微血管阻力明显相关（r = -0.59 [95% CI: -0.45 to -0.71]；P < 0.001）。在 CMD 和高微血管阻力患者中，管腔容积比对照组小 40%（512.8 ± 130.3 mm3 vs 853.2 ± 341.2 mm3；P < 0.001）。冠状动脉 CTA 评估的心外膜管腔容积与最小微血管阻力独立相关（P < 0.001）。冠状动脉CTA评估的管腔容积对检测微血管高阻力的预测能力曲线下面积为0.79（95% CI：0.69-0.88）：结论：与无 CMD 患者相比，患有 CMD 且微血管阻力高的患者心外膜血管更小。冠状动脉 CTA 能检测出高微血管阻力，具有很好的诊断能力。冠状动脉 CTA 有助于 ANOCA 患者的诊断。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Cardiovascular imaging CARDIAC & CARDIOVASCULAR SYSTEMS-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

24.90

自引率

5.70%

发文量

330

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Imaging, part of the prestigious Journal of the American College of Cardiology (JACC) family, offers readers a comprehensive perspective on all aspects of cardiovascular imaging. This specialist journal covers original clinical research on both non-invasive and invasive imaging techniques, including echocardiography, CT, CMR, nuclear, optical imaging, and cine-angiography. JACC. Cardiovascular imaging highlights advances in basic science and molecular imaging that are expected to significantly impact clinical practice in the next decade. This influence encompasses improvements in diagnostic performance, enhanced understanding of the pathogenetic basis of diseases, and advancements in therapy. In addition to cutting-edge research,the content of JACC: Cardiovascular Imaging emphasizes practical aspects for the practicing cardiologist, including advocacy and practice management.The journal also features state-of-the-art reviews, ensuring a well-rounded and insightful resource for professionals in the field of cardiovascular imaging.