非冠状动脉梗阻性缺血性心脏病冠状动脉微血管功能障碍与左室收缩功能的相关性  

Correlation between coronary microvascular dysfunction and left ventricular systolic function in patients with non-obstructive coronary artery disease

作　　者：朱艳艳 丁明岩 冀威 张慧慧[1] 李颖[1] 郭丽娟 刘婷婷[1] 朱芳[1] ZHU Yanyan;DING Mingyan;JI Wei;ZHANG Huihui;LI Ying;GUO Lijuan;LIU Tingting;ZHU Fang(Department of Cardiac Function,People’s Hospital of China Medical University,Shenyang 110000,China)

机构地区：[1]中国医科大学人民医院心功能科,沈阳市110000

出　　处：《临床超声医学杂志》2021年第7期511-515,共5页Journal of Clinical Ultrasound in Medicine

基　　金：辽宁省科学技术计划基金项目(20180530109)。

摘　　要：目的应用腺苷负荷状态下经胸冠状动脉血流显像技术(TTDE)评价非冠状动脉梗阻性缺血性心脏病(INOCA)女性冠状动脉微血管功能障碍(CMD),并分析其与静息、负荷状态下左室收缩功能的关系。方法选取疑似心绞痛症状且近3个月内冠状动脉造影提示冠状动脉狭窄(<50%)的女性患者,均行腺苷负荷状态下TTDE检查。根据TTDE测得冠状动脉血流速度储备(CFVR)进行分组,其中CFVR<2.0者26例为病例组,CFVR>2.5者33例为对照组。于腺苷负荷状态及静息状态下行常规超声心动图和二维斑点追踪技术检查,获取腺苷负荷状态下和静息状态下的左室整体纵向应变(GLS),二者差值即为左室整体纵向收缩储备(ΔGLS)。比较两组患者静息状态下常规超声心动图各参数及ΔGLS的差异。应用多元线性回归分析上述各参数与CFVR的相关性。结果病例组的年龄、负荷状态下收缩压和舒张压、静息状态下心率,以及糖尿病、高血压病、高脂血症比例均高于对照组,差异均有统计学意义(均P<0.05);病例组负荷状态下GLS、ΔGLS均低于对照组,差异均有统计学意义(均P<0.05)。相关性分析显示:CMD患者CFVR与静息状态下心率、负荷状态下GLS、ΔGLS均相关(r=-0.378、0.320、0.615,均P<0.05)。经多元线性回归分析调整年龄、糖尿病、高血压病、高脂血症、负荷状态下收缩压和舒张压、静息状态下心率、负荷状态下GLS影响因素后发现,CFVR与ΔGLS呈独立相关(β=0.906,P<0.05)。结论TTDE技术可以早期评价INOCA女性患者CMD,且CFVR与ΔGLS相关,CFVR越低,左室收缩储备功能越低。Objective obstructive ischemic heart disease(INOCA)by adenosine stress transthoracic coronary flow imaging(TTDE),and to analyze its relationship with left ventricular systolic function at rest and stress status.Methods having angina pectoris and stenosis(<50%)revealed by angiography in the past 3 months were selected.All patients underwent TTDE examination under adenosine load.According to TTDE measurement of coronary flow velocity reserve(CFVR),the patients were divided into two groups,26 patients with CFVR<2.0 in the case group,33 patients with CFVR>2.5 in the control group.The left ventricular global longitudinal strains(GLS)was obtained by conventional echocardiography and twodimensional speckle tracking technique in resting state and adenosine loading state.The difference between the two states was the left ventricular global longitudinal systolic reserve(ΔGLS).The parameters of conventional echocardiographic parameters andΔGLS were compared between the two groups in resting state.Multiple linear regression was used to analyze the correlation between the above parameters and CFVR.Results diabetes,hypertension and hyperlipidemia in the case group were higher than those in the control group at age and load level(all P<0.05).GLS in the case group under load andΔGLS were lower than those in the control group,the difference were statistically significant(both P<0.05).Correlation analysis showed that CFVR of CMD patients was correlated with GLS andΔGLS with resting heart rate and under load state(r=-0.378,0.320,0.615,all P<0.05).After adjusting of age,diabetes,hypertension,hyperlipidemia,systolic blood pressure and diastolic blood pressure,resting heart rate and GLS under load by multiple linear regression analysis,it showed that CFVR andΔGLS were independently correlated(β=0.906,P<0.05).Conclusion technology can early evaluate the left ventricular systolic reserve function of CMD in female patients with coronary nonobstructive ischemic heart disease,and CFVR is related toΔGLS.The lower the CFVR,the lower t

关 键 词：斑点追踪技术 二维 冠状动脉血流显像 经胸 冠状动脉微循环障碍 心室功能 左 

分 类 号：R540.45[医药卫生—心血管疾病] R541.9[医药卫生—内科学]