Myocardial blood flow mechanism of mental stress-induced myocardial ischemia in women with ANOCA

IF 4.6 2区综合性期刊 Q1 MULTIDISCIPLINARY SCIENCES

iScience Pub Date : 2024-11-01 DOI:10.1016/j.isci.2024.111302

Han Yin , Fengyao Liu , Bingqing Bai , Quanjun Liu , Yuting Liu , Haochen Wang , Yu Wang , Yannis Yan Liang , Anbang Liu , Xueju Yu , Cheng Jiang , Chao Wu , Bo Kong , Jingjin Liu , Lan Guo , Hongwen Fei , Shuxia Wang , Wei Jiang , Huan Ma , Qingshan Geng

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Abstract

Mental stress-induced myocardial ischemia (MSIMI) is linked to a 2-fold increase in cardiovascular events, but its underlying myocardial blood flow (MBF) mechanisms remain underexplored. Using nitrogen-13-ammonia cardiac positron emission tomography-computed tomography (PET-CT) assessing myocardial perfusion defect and MBF under resting, mental stress (MS), adenosine stress (AS) conditions, angina with no obstructive coronary artery disease (ANOCA) women showed a significantly higher prevalence of MSIMI compared to age-matched healthy controls (36/84 vs. 1/42, p < 0.001). The MBF_AS and rate-pressure product-corrected MBF_MS were consistently lower, especially in the left anterior descending artery territory, in participants with increased perfusion defect scores under MS. The lowest values of restricted coronary flow reserve and corrected MBF_MS in participants of ANOCA&MSIMI+ group indicated that impaired coronary microvascular function and mismatch between myocardial blood supply and demand together constitute the pathogenic mechanism of MSIMI in ANOCA population. These findings deepen our understanding of the pathophysiological mechanisms of MSIMI and confirm the long-standing hypothesis of the involvement of impaired coronary microvascular function.

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精神压力诱发 ANOCA 女性心肌缺血的心肌血流机制

精神压力诱发的心肌缺血（MSIMI）与心血管事件增加2倍有关，但其潜在的心肌血流（MBF）机制仍未得到充分探索。使用氮-13-氨心脏正电子发射断层扫描（PET-CT）评估静息、精神压力（MS）、腺苷压力（AS）条件下的心肌灌注缺损和心肌血流（MBF），与年龄匹配的健康对照组相比，无阻塞性冠状动脉疾病（ANOCA）女性心绞痛患者的 MSIMI 患病率明显更高（36/84 对 1/42，p <0.001）。在 MS 下灌注缺损评分增加的参与者中，MBFAS 和速率-压力乘积校正 MBFMS 一直较低，尤其是在左前降支动脉区域。ANOCA&MSIMI+组受试者受限冠脉血流储备和校正MBFMS值最低，表明冠状微血管功能受损和心肌供血与需求不匹配共同构成了ANOCA人群MSIMI的致病机制。这些发现加深了我们对MSIMI病理生理机制的理解，并证实了冠状动脉微血管功能受损这一由来已久的假说。

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

iScience Multidisciplinary-Multidisciplinary

CiteScore

7.20

自引率

1.70%

发文量

1972

审稿时长

6 weeks

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