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
{"title":"冠状动脉微血管功能障碍的血管重塑","authors":"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","doi":"10.1016/j.jcmg.2024.07.018","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Approximately half of the patients with angina and nonobstructive coronary artery disease (ANOCA) have evidence of coronary microvascular dysfunction (CMD).</p><p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 mm<sup>3</sup> vs 853.2 ± 341.2 mm<sup>3</sup>; 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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":" ","pages":""},"PeriodicalIF":12.8000,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Vascular Remodeling in Coronary Microvascular Dysfunction.\",\"authors\":\"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\",\"doi\":\"10.1016/j.jcmg.2024.07.018\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Approximately half of the patients with angina and nonobstructive coronary artery disease (ANOCA) have evidence of coronary microvascular dysfunction (CMD).</p><p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 mm<sup>3</sup> vs 853.2 ± 341.2 mm<sup>3</sup>; 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).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":14767,\"journal\":{\"name\":\"JACC. Cardiovascular imaging\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":12.8000,\"publicationDate\":\"2024-08-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JACC. 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Vascular Remodeling in Coronary Microvascular Dysfunction.
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.
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.
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