非阻塞性冠状动脉疾病女性患者冠状动脉血流储备异常的预测因素

doi:10.3969/j.issn.1004-583X.2022.09.004

摘要/Abstract

摘要：

目的探讨非阻塞性冠状动脉疾病女性患者的冠状动脉血流储备(CFR)异常的预测因素和临床特点。方法回顾性分析非阻塞性冠状动脉疾病女性患者223例,包括一般临床特点、生命体征、在院期间超声左心室射血分数、核素心肌血流定量显像以及实验室血液检测指标,其中左心室整体CFR值≥2.5为CFR正常组,左心室整体CFR值<2.5为CFR异常组。结果 CFR异常组的总胆固醇和低密度脂蛋白胆固醇(LDL-C)水平明显高于CFR正常组(P=0.011,P=0.002)。多因素分析显示,仅LDL-C是CFR异常的独立预测因素(OR=3.346;95%CI=1.254-8.930;P=0.016)。ROC曲线分析显示预测CFR异常的最佳LDL-C截断值为3.36 mmol/L,敏感性为40%,特异性为77%(AUC=0.609;95%CI=0.535-0.683)。结论在非阻塞性冠状动脉疾病女性患者中,LDL-C水平是CFR异常的独立预测因素,LDL-C水平高于正常的女性,更容易合并冠状动脉微血管功能障碍。

关键词: 冠状动脉疾病, 微血管功能障碍, 放射性核素显像, 心肌灌注显像, 血流储备分数, 心肌

Abstract:

Objective To explore the predictors and clinical features of abnormal coronary flow reserve (CFR) in women with non-obstructive coronary artery disease (NOCAD). Methods We performed a retrospective analysis of 223 NOCAD female patients from the aspects of general clinical features, vital signs, left-ventricular ejection fraction (LVEF) on the echocardiography during hospitalization, nuclear myocardial perfusion imaging parameters and laboratory blood tests indexes for further statistical analysis. The patients were divided into two groups: normal CFR group (CFR≥2.5) and abnormal CFR group (CFR<2.5). Results The levels of total cholesterol and low density lipoprotein cholesterol (LDL-C) were significantly higher in abnormal CFR group than those in normal CFR group (P=0.011, P=0.002). Multiple logistic regression analysis revealed that LDL-C level was only found to be independently associated with abnormal CFR (OR=3.346; 95%CI=1.254-8.930; P=0.016). The receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off value of LDL-C level for predicting abnormal CFR was 3.36 mmol/L with a sensitivity of 40% and specificity of 77% (AUC=0.609; 95%CI=0.535-0.683).Conclusion The LDL-C level is found to be independently associated with abnormal CFR in NOCAD female patients, and coronary microvascular dysfunction is more likely to occur in women with abnormal LDL-C level.

Key words: coronary artery disease, microvascular dysfunction, radionuclide imaging, myocardial perfusion imaging, fractional flow reserve, myocardial

中图分类号:

R541.4

王雅洁, 李剑明, 刘菁晶, 卢宇杰, 林文华. 非阻塞性冠状动脉疾病女性患者冠状动脉血流储备异常的预测因素[J]. 临床荟萃, 2022, 37(9): 791-795.

Wang Yajie, Li Jianming, Liu Jingjing, Lu Yujie, Lin Wenhua. Predictor analysis of abnormal coronary flow reserve in women with non-obstructive coronary artery disease[J]. Clinical Focus, 2022, 37(9): 791-795.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.09.004

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I9/791

图/表 3

参考文献 19

[1]	Vancheri F, Longo G, Vancheri S, et al. Coronary microvascular dysfunction[J]. J Clin Med, 2020, 9(9): 2880. doi: 10.3390/jcm9092880 URL
[2]	Aun JA, Hulten E, Saad E. Coronary microvascular disease: Coronary flow reserve and the complementary role of positron emission tomography and angiography[J]. BMJ Case Rep, 2022, 15(3): e248354. doi: 10.1136/bcr-2021-248354 URL
[3]	Phan A, Shufelt C, Merz CN. Persistent chest pain and no obstructive coronary artery disease[J]. JAMA, 2009, 301(14): 1468-1474. doi: 10.1001/jama.2009.425 pmid: 19351944
[4]	Gould KL, Bui L, Kitkungvan D, et al. Reliability and reproducibility of absolute myocardial blood flow: Does it depend on the PET/CT technology, the vasodilator, and/or the software?[J]. Curr Cardiol Rep, 2021, 23(3): 12. doi: 10.1007/s11886-021-01449-8 pmid: 33483794
[5]	Mayala HA, Bakari KH, Mghanga FP, et al. Clinical significance of PET-CT coronary flow reserve in diagnosis of non-obstructive coronary artery disease[J]. BMC Res Notes, 2018, 11(1): 566. doi: 10.1186/s13104-018-3667-0 pmid: 30081956
[6]	李剑明, 杨敏福, 何作祥. 放射性核素心肌血流定量显像在冠状动脉微血管功能障碍中的应用价值[J]. 中华心血管病杂志, 2020, 48(12): 1073-1077.
[7]	中华医学会心血管病学分会基础研究学组, 中华医学会心血管病学分会介入心脏病学组, 中华医学会心血管病学分会女性心脏健康学组等. 冠状动脉微血管疾病诊断和治疗的中国专家共识[J]. 中国循环杂志, 2017, 32(5): 421-430.
[8]	Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease: The task force on the management of stable coronary artery disease of the European Society of Cardiology[J]. Eur Heart J, 2013, 34(38): 2949-3003. doi: 10.1093/eurheartj/eht296 pmid: 23996286
[9]	中国老年医学学会心血管病分会. 中国多学科微血管疾病诊断与治疗专家共识[J]. 中国循环杂志, 2020, 35(12): 1149-1165.
[10]	Padro T, Manfrini O, Bugiardini R, et al. ESC working group on coronary pathophysiology and microcirculation position paper on 'coronary microvascular dysfunction in cardiovascular disease'[J]. Cardiovasc Res, 2020, 116(4): 741-755. doi: 10.1093/cvr/cvaa003 pmid: 32034397
[11]	Wu P, Zhang X, Wu Z, et al. Impaired coronary flow reserve in patients with supra-normal left ventricular ejection fraction at rest[J]. Eur J Nucl Med Mol Imaging, 2022, 49(7):2189-2198. doi: 10.1007/s00259-021-05566-y URL
[12]	Maredziak M, Bengs S, Portmann A, et al. Microvascular dysfunction and sympathetic hyperactivity in women with supra-normal left ventricular ejection fraction (snLVEF)[J]. Eur J Nucl Med Mol Imaging, 2020, 47(13): 3094-3106. doi: 10.1007/s00259-020-04892-x URL
[13]	Sakuma H, Ishida M. Advances in myocardial perfusion MR imaging: Physiological implications, the importance of quantitative analysis, and impact on patient care in coronary artery disease[J]. Magn Reson Med Sci, 2022, 21(1): 195-211. doi: 10.2463/mrms.rev.2021-0033 URL
[14]	Zhang X, Li H, Wu P, et al. The diagnosis and prognosis of coronary microvascular disease using PET/CT[J]. Eur J Nucl Med Mol Imaging, 2022, 80(2): 153-166.
[15]	Wijnen WJ, Warnock GI, Etter D, et al. Clinical significance of corrected relative flow reserve derived from (13)N-ammonia positron emission tomography combined with coronary computed tomography angiography[J]. Eur J Nucl Med Mol Imaging, 2021, 28(5): 1851-1860. doi: 10.1007/s002590100604 URL
[16]	Promteangtrong C, Jantarato A, Kunawudhi A, et al. Clinical impact of quantitative [¹⁵O] H₂O PET/CT myocardial perfusion imaging on decision-making regarding invasive management of coronary artery disease[J]. J Nucl Cardiol, 2022, 29(4):1887-1899. doi: 10.1007/s12350-021-02604-y URL
[17]	Kim SC, Di Carli MF, Garg RK, et al. Asymptomatic hyperuricemia and coronary flow reserve in patients with metabolic syndrome[J]. J Int Med Res, 2018, 2: 17.
[18]	Bakari KH, Mkangala A, Magesa M, et al. Coronary microvascular dysfunction and cardiovascular risk in obese patients[J]. BMC Res Notes, 2018, 72(7): 707-717.
[19]	Mayala HA, Yan W, Jing H, et al. Clinical characteristics and biomarkers of coronary microvascular dysfunction and obstructive coronary artery disease[J]. 2019, 47(12): 6149-6159.

项目	CFR正常组(n=114)	CFR异常组(n=109)	统计值	P值
年龄(岁)	60.31±8.66	62.49±8.15	-1.934	0.054
BMI(kg/m²)	25.08(4.97)	25(4.44)	-0.105	0.916
高血压[例(%)]	62(54.4)	58(53.2)	0.031	0.860
糖尿病[例(%)]	29(25.4)	29(26.6)	0.039	0.843
目前仍吸烟[例(%)]	11(9.6)	12(11.0)	0.111	0.739
收缩压(mmHg)	130.50(20.25)	133(19)	-0.925	0.355
舒张压(mmHg)	79(15.5)	78(14.5)	-0.316	0.752
心率(次/min)	70(16)	72(13)	-0.564	0.573
白细胞总数(10⁹/L)	5.5(1.85)	5.3(1.7)	-0.364	0.716
血红蛋白(g/L)	131.09±10.40	132.80±9.55	-1.277	0.203
血小板计数(10⁹/L)	243.90±65.46	249.28±55.22	-0.662	0.509
空腹血糖(mmol/L)	5.3(1.43)	5.4(1.75)	-0.642	0.521
肌酐(μmol/L)	50(10.5)	53(12)	-1.193	0.233
MDRD-eGFR[ml/(min·1.73 m²)]	116.87±22.01	112.52±24.52	1.394	0.165
尿酸(μmol/L)	288.09±70.32	300.60±74.25	-1.292	0.198
总胆固醇(mmol/L)	4.6(1.1)	4.8(1.55)	-2.538	0.011
甘油三酯(mmol/L)	1.39(1.02)	1.32(0.92)	-1.136	0.256
HDL-C(mmol/L)	1.29(0.45)	1.26(0.32)	-0.383	0.702
LDL-C(mmol/L)	2.78±0.87	3.17±0.97	-3.182	0.002
LVEF(%)	66(6)	66(6)	-0.226	0.821
左心室整体CFR值	3.20(0.84)	1.85(0.70)	-12.901	<0.01
左心室静息心肌血流量[ml/(min·g)]	0.9(0.13)	0.89(0.12)	-0.262	0.793
左心室负荷心肌血流量[ml/(min·g)]	2.81±0.67	1.60±0.42	16.319	<0.01

项目	CFR正常组(n=114)	CFR异常组(n=109)	统计值	P值
年龄(岁)	60.31±8.66	62.49±8.15	-1.934	0.054
BMI(kg/m²)	25.08(4.97)	25(4.44)	-0.105	0.916
高血压[例(%)]	62(54.4)	58(53.2)	0.031	0.860
糖尿病[例(%)]	29(25.4)	29(26.6)	0.039	0.843
目前仍吸烟[例(%)]	11(9.6)	12(11.0)	0.111	0.739
收缩压(mmHg)	130.50(20.25)	133(19)	-0.925	0.355
舒张压(mmHg)	79(15.5)	78(14.5)	-0.316	0.752
心率(次/min)	70(16)	72(13)	-0.564	0.573
白细胞总数(10⁹/L)	5.5(1.85)	5.3(1.7)	-0.364	0.716
血红蛋白(g/L)	131.09±10.40	132.80±9.55	-1.277	0.203
血小板计数(10⁹/L)	243.90±65.46	249.28±55.22	-0.662	0.509
空腹血糖(mmol/L)	5.3(1.43)	5.4(1.75)	-0.642	0.521
肌酐(μmol/L)	50(10.5)	53(12)	-1.193	0.233
MDRD-eGFR[ml/(min·1.73 m²)]	116.87±22.01	112.52±24.52	1.394	0.165
尿酸(μmol/L)	288.09±70.32	300.60±74.25	-1.292	0.198
总胆固醇(mmol/L)	4.6(1.1)	4.8(1.55)	-2.538	0.011
甘油三酯(mmol/L)	1.39(1.02)	1.32(0.92)	-1.136	0.256
HDL-C(mmol/L)	1.29(0.45)	1.26(0.32)	-0.383	0.702
LDL-C(mmol/L)	2.78±0.87	3.17±0.97	-3.182	0.002
LVEF(%)	66(6)	66(6)	-0.226	0.821
左心室整体CFR值	3.20(0.84)	1.85(0.70)	-12.901	<0.01
左心室静息心肌血流量[ml/(min·g)]	0.9(0.13)	0.89(0.12)	-0.262	0.793
左心室负荷心肌血流量[ml/(min·g)]	2.81±0.67	1.60±0.42	16.319	<0.01

预测变量	单因素分析							多因素分析
	回归系数	标准误	Wald χ²值	P值	OR值	95%CI		回归系数	标准误	Wald χ²值	P值	OR值	95%CI
	回归系数	标准误	Wald χ²值	P值	OR值			回归系数	标准误	Wald χ²值	P值	OR值			下限	上限	下限	上限
年龄	0.031	0.016	3.649	0.056	1.032	0.999	1.065	0.031	0.017	3.296	0.069	1.031	0.998	1.065
总胆固醇	0.330	0.134	6.028	0.014	1.390	1.069	1.809	-0.702	0.442	2.526	0.112	0.496	0.209	1.178
LDL-C	0.469	0.154	9.327	0.002	1.598	1.183	2.160	1.208	0.501	5.816	0.016	3.346	1.254	8.930

预测变量	单因素分析							多因素分析
	回归系数	标准误	Wald χ²值	P值	OR值	95%CI		回归系数	标准误	Wald χ²值	P值	OR值	95%CI
	回归系数	标准误	Wald χ²值	P值	OR值			回归系数	标准误	Wald χ²值	P值	OR值			下限	上限	下限	上限
年龄	0.031	0.016	3.649	0.056	1.032	0.999	1.065	0.031	0.017	3.296	0.069	1.031	0.998	1.065
总胆固醇	0.330	0.134	6.028	0.014	1.390	1.069	1.809	-0.702	0.442	2.526	0.112	0.496	0.209	1.178
LDL-C	0.469	0.154	9.327	0.002	1.598	1.183	2.160	1.208	0.501	5.816	0.016	3.346	1.254	8.930