非阻塞性冠状动脉缺血疾病微循环和左室舒张功能关系的探讨  

Relationship between microcirculation and left ventricular diastolic function in Ischaemia patients with Non-Obstructive Coronary Arteries

作　　者：姜涛 陈亚南 郭秋红 王红 翟玉民 Jiang Tao;Chen Ya'nan;Guo Qiuhong;Wang Hong;Zhai Yumin(Department of Cardiology,Kaifeng Hospital of Traditional Chinese Medicine,Henan Province,Kaifeng 475000,China;不详)

机构地区：[1]开封市中医院心内科,开封475000 [2]开封市中心医院心内科,开封475000 [3]开封市中心医院超声室,开封475000

出　　处：《中国循证心血管医学杂志》2023年第5期565-568,577,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：河南省医学科技攻关计划项目基金资助项目(LHGJ20191173);开封市科技发展计划项目基金资助项目(2003076)。

摘　　要：目的 探讨非阻塞性冠状动脉(冠脉)缺血疾病患者微循环功能和左室舒张功能之间的关系。方法 入选2018年12月至2021年10月就诊于开封市中医院心内科,有明显胸痛、胸闷症状,但冠脉造影或冠脉CT血管成像结果显示正常或无严重狭窄(<50%)的患者210例为研究对象。所有患者均行超声心动图检查,测量二尖瓣血流速度E峰(E)、二尖瓣环组织多普勒速度(e’),以E/e’表示左室舒张功能;应用三磷酸腺苷负荷心肌声学造影(MCE)评估冠脉血流储备(CFR)反映左室微循环功能,根据CFR值分为正常组(CFR≥2,n=134)以及微循环功能障碍(CMD)组(CFR<2,n=76),通过多因素Logistic回归分析明确微循环功能和左室舒张功能之间是否存在相关性。结果 与正常组相比,CMD组年龄明显增高,合并高血压、糖尿病及房颤比例较正常组明显增多(P<0.05);在心脏超声方面,CMD组左室质量指数(LVmassi)、室间隔厚度均高于正常组[106.5 (90~131)vs.98.1 (72~128),P=0.039]、[11.4(8.5~13.1)vs.9.6 (7.4~12.5),P=0.047],差异均有统计学意义。多因素Logistic回归分析显示:年龄、糖尿病是非阻塞性冠脉缺血疾病患者发生微循环功能障碍的预测因素,而针对该人群,左室舒张功能障碍和微循环功能障碍之间无明显相关性。结论 非阻塞性冠脉缺血疾病患者左室舒张功能和微循环功能之间无明显相关性。Objective To investigate the relationship between micro-circulation and left ventricular diastolic function in Ischaemia patients with Non-Obstructive Coronary Arteries.Methods Enrolled patients who visited the Department of Cardiology of Kaifeng City Hospital of traditional Chinese medicine from December 2018 to October 2021 and had apparent symptoms of chest pain and chest tightness,but the results of coronary angiography or coronary CT vascular imaging showed normal or no severe stenosis(<50%)210 were the subjects of the study.All patients underwent echocardiography to measure mitral flow velocity e peak(E),mitral annular tissue Doppler velocity(E'),and LV diastolic function expressed as E/E';Myocardial acoustic angiography(MCE)with adenosine triphosphate loading was used to assess coronary flow reserve(CFR)to reflect LV microcirculatory function.patients were divided into normal(CFR≥2,n=134)as well as microcirculatory dysfunction(CMD)groups(CFR<2,n=76)based on CFR values.Multivariate logistic regression analysis aimed to determine whether there was a correlation between microcirculatory function and LV diastolic function.Results Compared with the normal group,the CMD group was significantly older and had a higher proportion of comorbid hypertension,diabetes mellitus,and atrial fibrillation than the normal group(P<0.05).On cardiac ultrasound,left ventricular mass index(LVmassi)and interventricular septum thickness were higher in the CMD group than in the normal group[106.5(90~131)us.98.1(72~128),P=0.039],and[11.4(8.5~13.1)vs.9.6(7.4~12.5),P=0.047],respectively.Multivariate logistic regression analysis showed that:age and diabetes mellitus were predictors of the development of microcirculatory dysfunction in patients with nonobstructive coronary ischemic disease,whereas,for this population,no significant correlation was found between LV diastolic dysfunction and microcirculatory dysfunction.Conclusion There was no relationship between left ventricular diastolic function and coronary microvascular function in

关 键 词：非阻塞性冠状动脉缺血疾病 舒张功能 微循环功能 冠脉血流储备 

分 类 号：R543.31[医药卫生—心血管疾病]