Risk and related factors of coronary microvascular disease in patients with chest pain based on CZT-SPECT
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摘要: 目的 基于碲锌镉(CZT)心脏专用SPECT机(CZT-SPECT)测定可疑或已确诊冠心病胸痛患者的冠状动脉(冠脉)血流储备(CFR)，初步探讨冠脉微血管功能障碍(CMVD)的发生风险及相关危险因素。方法 回顾性分析2021年1月—2021年3月于我院因胸痛行冠脉造影(CAG)及CZT-SPECT检查，且无需血运重建治疗的患者。根据CFR分为CMVD组(55例)和对照组(74例)。比较两组患者的临床特征，初步分析CMVD的相关危险因素。结果 129例患者平均年龄(61.63±9.11)岁，CMVD组共55例，发病率约42.6%。CMVD组BMI、TC、LDL-C、LVEDD、T波倒置比例高于对照组，BMI>24 kg/m2的患者比例高于对照组(78.2%∶54.1%，P＜0.05)。两组各支冠脉静息心肌血流量(MBF)无明显差异，而CMVD组负荷MBF明显降低(P＜0.01)。经年龄校正，多因素logistic回归分析显示，BMI、LDL-C升高和T波倒置与CMVD独立相关(P＜0.05)。结论 在疑诊或确诊冠心病的胸痛患者中，CMVD的发生风险比较高，BMI和LDL-C升高、T波倒置是胸痛患者发生CMVD的独立危险因素。
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关键词:
- 冠心病 /
- 微血管性心绞痛 /
- 冠状动脉血流储备 /
- 单光子发射型断层成像 /
- 心肌灌注显像
Abstract: Objective To investigate the risk factors of coronary microvascular dysfunction(CMVD) in patients with chest pain of suspected or confirmed coronary heart disease based on coronary flow reserve(CFR) from zinc-cadmium telluride(CZT-SPECT) special SPECT.Methods A retrospective analysis was performed on 129 patients who underwent coronary angiography(CAG) and CZT-SPECT for chest pain without revascularization at TEDA International Cardiovascular Hospital from January 2021 to March 2021. They were divided into CMVD group(n=55) and control group(n=74) according to CFR. The clinical characteristics of the two groups were compared, and the risk factors related to CMVD were preliminarily analyzed.Results A total of 129 patients was an average age of(61.63±9.11) years. The proportion of BMI, TC, LDL-C, LVEDD and T wave inversion in CMVD group was higher than those in control group. The proportion of patients with BMI>24 kg/m2was higher than the control group(78.2%∶ 54.1%, P < 0.05). There was no significant difference between the two groups in the resting MBF of each branch of the coronary artery, while the CMVD group had a significant decrease in MBF(P < 0.01). After adjusting for age, multivariate Logistic regression analysis showed that increased BMI and LDL-C, T wave inversion were independently associated with CMVD(P < 0.05).Conclusion In patients with chest pain suspected or confirmed coronary heart disease, the risk of CMVD is relatively high. Increased BMI, LDL-C and T wave inversion are independent risk factors of CMVD in patients with chest pain. -
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表 1 CMVD组和对照组基线资料比较
Table 1. General data
例(%), X±S 项目 CMVD组(55例) 对照组(74例) t或x2值 P值 女性 26(47.3) 33(44.6%) 0.091 0.763 年龄/岁 61.95±9.37 60.85±8.49 1.927 0.066 NOCA 28(50.9) 35(47.3) 0.368 0.544 PCI史 20(36.4) 27(36.5) 0.026 0.989 高血压 38(69.1) 55(74.3) 0.430 0.512 糖尿病 12(21.8) 14(18.9) 0.884 0.643 OMI 9(16.4) 9(12.3) 0.423 0.516 吸烟史 20(32.3) 25(37.9) 0.443 0.506 BMI≥24 kg/m2 43(78.2) 40(54.1) 6.005 0.005 BMI/(kg·m-2) 26.15±2.85 24.38±2.38 3.842 0.001 TC/(mmol·L-1) 4.74±0.99 4.38±0.99 2.668 0.011 LDL-C/(mmol·L-1) 2.93±0.89 2.29±0.94 4.531 0.001 Cr/(μmol·L-1) 62.43±14.21 66.85±18.09 1.482 0.141 T波倒置 25(45.5) 17(23.0) 7.262 0.007 心脏超声参数 LAD/mm 36.57±3.41 36.14±3.57 0.696 0.488 LVEDD/mm 46.70±3.50 45.29±3.95 2.095 0.038 LVEF/% 63.20±7.39 62.92±8.06 0.205 0.838 
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表 2 CMVD组和对照组MBF比较
Table 2. MBF in two groups
X±S 项目 CMVD组(55例) 对照组(74例) t值 P值 LAD静息MBF/(mL·g-1·min-1) 0.87±0.13 0.82±0.15 1.175 0.085 LAD负荷MBF/(mL·g-1·min-1) 1.41±0.47 2.47±0.74 -9.31 0.000 LCX静息MBF/(mL·g-1·min-1) 0.80±0.15 0.83±0.19 -1.02 0.309 LCX负荷MBF/(mL·g-1·min-1) 1.20±0.42 2.34±0.66 -11.20 0.000 LV静息MBF/(mL·g-1·min-1) 0.83±0.13 0.82±0.15 0.74 0.461 LV负荷MBF/(mL·g-1·min-1) 1.36±0.43 2.50±0.70 -10.573 0.000 RCA静息MBF/(mL·g-1·min-1) 0.82±0.16 0.85±0.39 -0.529 0.598 RCA负荷MBF/(mL·g-1·min-1) 1.45±0.57 2.66±0.93 -8.48 0.000
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表 3 多因素logistic回归分析
Table 3. Multivariate logistic regression analysis
变量 B值 SE Wald OR(95%CI) P值 年龄 0.032 0.024 1.730 0.969(0.924~1.016) 0.188 BMI 0.250 0.085 5.703 1.214(1.088~1.516) 0.003 TC 0.050 0.313 0.025 1.051(0.569~1.941) 0.874 LDL-C 0.828 0.341 3.909 2.159(0.974~4.464) 0.025 LVEDD 0.066 0.0610 1.180 1.069(0.948~1.205) 1.205 T波倒置 0.767 0.465 3.724 1.124(0.187~1.916) 0.039
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[1] 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. doi: 10.3969/j.issn.1000-3614.2017.05.003
[2] Sara JD, Widmer RJ, Matsuzawa Y, et al. Prevalence of coronary microvascular dysfunction among patients with chest pain and nonobstructive coronary artery disease[J]. JACC Cardiovasc Interv, 2015, 8(11): 1445-1453. doi: 10.1016/j.jcin.2015.06.017
[3] Gupta A, Taqueti VR, van de Hoef TP, et al. Integrated noninvasive physiological assessment of coronary circulatory function and impact on cardiovascular mortality in patients with stable coronary artery disease[J]. Circulation, 2017, 136(24): 2325-2336. doi: 10.1161/CIRCULATIONAHA.117.029992
[4] Kunadian V, Chieffo A, Camici PG, et al. An EAPCI expert consensus document on ischaemia with non-obstructive coronary arteries in collaboration with european society of cardiology working group on coronary pathophysiology & microcirculation endorsed by coronary vasomotor disorders international study group[J]. Eur Heart J, 2020, 41(37): 3504-3520. doi: 10.1093/eurheartj/ehaa503
[5] Wang J, Li S, Chen W, et al. Diagnostic efficiency of quantification of myocardial blood flow and coronary flow reserve with CZT dynamic SPECT imaging for patients with suspected coronary artery disease: a comparative study with traditional semi-quantitative evaluation[J]. Cardiovasc Diagn Ther, 2021, 11(1): 56-67. doi: 10.21037/cdt-20-728
[6] Pang Z, Wang J, Li S, et al. Diagnostic analysis of new quantitative parameters of low-dose dynamic myocardial perfusion imaging with CZT SPECT in the detection of suspected or known coronary artery disease[J]. Int J Cardiovasc Imaging, 2021, 37(1): 367-378. doi: 10.1007/s10554-020-01962-x
[7] Maron DJ, Hochman JS, Reynolds HR, et al. Initial invasive or conservative strategy for stable coronary disease[J]. N Engl J Med, 2020, 382(15): 1395-1407. doi: 10.1056/NEJMoa1915922
[8] 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. doi: 10.3969/j.issn.1000-3614.2020.12.001
[9] 王岚, 马玉良, 朱天刚, 等. 左室整体长轴应变对急性心肌梗死后冠状动脉微循环障碍的诊断价值[J]. 临床心血管病杂志, 2021, 37(10): 896-900. http://lcxb.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=a4331f67-70bb-4706-a998-e49d25f12c8f
[10] 韩梦月, 谢锋, 吴天慧, 等. PET/SPECT核素心肌显像对存活心肌检测的研究进展[J]. 临床心血管病杂志, 2020, 36(9): 790-793. http://lcxb.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=934dafb1-fe2c-40d3-ab1f-3e11e0de8340
[11] 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. doi: 10.3760/cma.j.cn112148-20200426-00349
[12] 陈炜佳, 姚康, 李晨光, 等. CZT-SPECT测定的冠状动脉血流储备对诊断冠心病的增益价值[J]. 中华核医学与分子影像杂志, 2019, 39(12): 714-719. doi: 10.3760/cma.j.issn.2095-2848.2019.12.003
[13] 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
[14] 王永德, 陈卫强, 李祎, 等. 非阻塞性冠状动脉疾病胸痛患者冠状动脉微血管疾病的PET/CT诊断及其相关因素初探[J]. 中华心血管病杂志, 2020, 48(11): 942-947. doi: 10.3760/cma.j.cn112148-20200409-00298
[15] 彭琨, 陈卫强, 王永德, 等. 13N-NH3·H2 O PET/CT显像血流储备测定对冠状动脉微血管疾病的诊断价值[J]. 中华核医学与分子影像杂志, 2019, 39(12): 708-713. doi: 10.3760/cma.j.issn.2095-2848.2019.12.002
[16] 武萍, 郭小闪, 张茜, 等. PET心肌血流绝对定量评估冠状动脉微血管疾病的临床研究[J]. 中华心血管病杂志, 2020, 48(3): 205-210. doi: 10.3760/cma.j.cn112148-20191024-00652-1
[17] 李强, 李艳兵, 陈明, 等. 尼可地尔联合阿托伐他汀治疗冠状动脉慢血流现象的疗效及其对近期预后的影响[J]. 临床心血管病杂志, 2019, 35(8): 697-701. http://lcxb.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=713aa304-5ab3-457f-ba49-82cbf94b7d7d
[18] Taqueti VR, Di Carli MF. Coronary microvascular disease pathogenic mechanisms and therapeutic options: JACC State-of-the-Art Review[J]. J Am Coll Cardiol, 2018, 72(21): 2625-2641. doi: 10.1016/j.jacc.2018.09.042
[19] Coutinho T, Mielniczuk LM, Srivaratharajah K, et al. Coronary artery microvascular dysfunction: Role of sex and arterial load[J]. Int J Cardiol, 2018, 270: 42-47. doi: 10.1016/j.ijcard.2018.06.072
[20] 彭琨, 陈卫强, 王永德, 等. 女性冠状动脉微血管性疾病的PET/CT定量参数及其相关危险因素分析[J]. 中华核医学与分子影像杂志, 2020, 40(11): 652-657. doi: 10.3760/cma.j.cn321828-20191018-00227
[21] 中国急性心肌梗死注册登记研究组. 中国急性心肌梗死患者发病前动脉粥样硬化性心血管疾病危险分层分析[J]. 中国循环杂志, 2021, 36(9): 852-857. doi: 10.3969/j.issn.1000-3614.2021.09.004
[22] Bajaj NS, Osborne MT, Gupta A, et al. Coronary microvascular dysfunction and cardiovascular risk in obese patients[J]. J Am Coll Cardiol, 2018, 72(7): 707-717. doi: 10.1016/j.jacc.2018.05.049
[23] Bailly M, Thibault F, Courtehoux M, et al. Myocardial flow reserve measurement during CZT-SPECT perfusion imaging for coronary artery disease screening: correlation with clinical findings and invasive coronary angiography-The CFR-OR Study[J]. Front Med(Lausanne), 2021, 8: 691893.
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