动态99m Tc-sestamibi CZT-SPECT评价老年胸痛患者冠状动脉微血管功能障碍的临床特征

Assessment of clinical characteristics of coronary microvascular dysfunction in elderly patients with chest pain by dynamic 99m Tc-sestamibi CZT-SPECT camera

中文关键词: 冠状动脉微血管功能障碍(CMVD)  冠状动脉血流储备(CFR)  冠心病(CAD)  单光子发射计算机断层显像(SPECT)  心肌灌注显像(MPI)

英文关键词: coronary microvascular dysfunction  coronary flow reserve  coronary artery disease  single-photon emission computed tomography  myocardial perfusion imaging

中文摘要:

      目的 冠状动脉微血管功能障碍(coronary microvascular dysfunction,CMVD)常介导非内皮依赖性微血管的异常扩张,引起缺血和心绞痛.对于无心外膜冠状动脉狭窄的心血管疾病,微血管病变起着非常重要的作用,并与心血管事件的增加有关.冠状动脉血流储备(coronary flow reserve,CFR)是微血管水平检测冠状动脉硬化早期征象的最敏感参数之一.新型动态99m Tc-sestamibi CZT-SPECT评估CFR已成为检测CMVD的一种很有希望的技术.我们旨在通过冠状动脉造影和动态CZT-SPECT描述胸痛患者CMVD的患病率、临床特征和预后.方法 入选2020 年1 月至2022 年1 月因胸痛在华东医院住院的老年(年龄≥60 岁患者298 例).他们均接受了冠状动脉造影和动态/常规状态下静息/负荷门控心肌灌注显像(myocardial perfusion imaging,MPI).在血管水平上,如果任何冠状动脉狭窄＜50%且CFR＜2,则认为是CMVD.在患者层面,CMVD被认为是非阻塞性冠心病(coronary artery disease,CAD)的一种.我们还收集了病史、生化指标等信息.随访至2023 年6 月30 日.主要不良心血管事件(major adverse cardiovascular event,MACE)定义为:因胸闷胸痛再住院、急性冠脉综合征和死亡.结果 73.5%的患者有心绞痛但冠脉造影阴性.30.9%非阻塞性CAD患者有CMVD.非阻塞性CAD中,CFR＜2 组MACE发生率较CFR≥2 组高(P＜0.001).在Logistic回归分析中,发现糖尿病(β 1.837,OR 6.227,95%CI 3.071～12.831,P＜0.001)、冠状动脉慢血流(coronary slow flow,CSF)(β 1.150,OR 3.157,95%CI 1.341～7.434,P =0.009)和高脂血症(β 0.832,OR 2.297,95%CI 1.052～5.016,P =0.037)为CMVD的重要预测因子.结论 在非阻塞性CAD患者中CMVD的MACE发生率高.糖尿病、高脂血症和CSF是CMVD的独立预测因子.采用动态99m Tc-sestamibi CZT-SPECT定量CFR检测在技术上是可行的,可以反映冠状动脉微血管功能.

英文摘要:

      Objective Coronary microvascular dysfunction(CMVD)often mediates abnormal expansion of non-endo-thelial dependent microvessels and causes ischemia and angina pectoris.For cardiovascular diseases without epicardial coronary artery stenosis,microvascular lesions play a very important role and are related to the increase in cardiovascular events.Coro-nary flow reserve(CFR)is one of the most sensitive parameters to detect the early signs of coronary atherosclerosis at the mi-crovascular level.The new dynamic 99m Tc-sestamibi CZT-SPECT for evaluating CFR has emerged as a promising technique for determination of CMVD.We aimed to describe the prevalence,clinical features,and prognosis of CMVD in patients with chest pain by coronary angiography and dynamic CZT-SPECT.Methods A total of 298 elderly patients(aged≥60 years)who were hospitalized in Huadong Hospital due to chest pain from January 2020 to January 2022 were selected.They all underwent coronary angiography and rest/stress dynamic and routine gated myocardial perfusion imaging(MPI).At the vascular level,if any coronary artery stenosis＜50%and CFR＜2,it was considered CMVD.At the patient level,CMVD was considered a type of non-obstructive coronary artery disease(CAD).The medical history,biochemical indicators,and other information of the patients were collected.The follow-up was conducted until June.30,2023.The major adverse cardiovascular event(MACE)was defined as readmission due to chest tightness and pain,acute coronary syndrome(ACS)and death.Results 73.5%of the patients had angina,but their coronary angiography was negative.30.9%of patients with non-obstructive CAD had CM-VD.In non-obstructive CAD patients,the incidence of MACE in the CFR＜2 group was higher than that in the CFR≥2 group(P＜0.001).Logistic regression analysis found that diabetes(β 1.837,OR 6.227,95%CI 3.071-12.831,P＜0.001),coro-nary slow flow(CSF)(β 1.150,OR 3.157,95%CI 1.341-7.434,P =0.009)and hyperlipidemia(β 0.832,OR 2.297,95%CI1.052-5.016,P =0.037)were important predictors of CMVD.Conclusion Among non-obstructive CAD patients,CMVD patients have a higher incidence of MACE.Diabetes,hyperlipidemia and CSF are independent predictors of CMVD.Quantitative CFR detection by dynamic 99m Tc-sestamibi CZT-SPECT is technically feasible and can reflect coronary microvascu-lar function.