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  • Title: [Coronary microvascular resistance and its relevant factors in patients with moderate coronary stenosis and chest pain].
    Author: He DF, Liu MY, Zhang LJ, Guo CJ, Chi YP, Zhao L, Zhang XJ.
    Journal: Zhonghua Nei Ke Za Zhi; 2018 Apr 01; 57(4):270-274. PubMed ID: 29614585.
    Abstract:
    Objective: To evaluate the impact of cardiovascular risk factors on index of microvascular resistance (IMR) and coronary flow reserve (CFR) and to explore the characteristics of IMR and CFR and the relationship between IMR and angiographic features in patients with intermediate coronary stenosis and chest pain. Methods: Fractional flow reserve (FFR), CFR, and IMR were measured in patients who underwent invasive coronary angiography with 40%-70% stenosis by visual assessment. All patients with FFR>0.75 were enrolled and grouped with the cut-off points of IMR≥25 and CFR≤2.0. Patients with IMR≥25 were group H, including two sub-groups (high IMR-low CFR, group H1 and high IMR-high CFR, group H2), while those with IMR<25 were group N. The thrombolysis in myocardial infarction (TIMI) frame were counted. Results: A total of 34 patients with FFR>0.75 were enrolled with 61.8%(21 cases) of males and 38.2% (13 cases) of females. The mean age was (57.3±8.1) years old. High IMR accounted for 47.1% of all cases. There was significant difference between group H and N in TIMI frame (33.0 vs. 20.8, P=0.031). There were significant differences between group H1 and H2 in homocysteine (17.8 µmol/L vs. 12.0 µmol/L, P=0.005) and IMRcorr (58.0 vs. 36.1, P=0.002). IMRcorr was correlated to TIMI frame (r=0.40, P=0.012) for all cases. The sensitivity and specificity of inferring IMR≥35.3 by TIMI frame were 0.75 and 0.65 (P=0.049) with TIMI frame over 40.5. Conclusions: High IMR may be one of the reasons for chest pain in patients with intermediate coronary stenosis. There is no correlation between vascular risk factors and IMR or CFR, while there is positive correlation between TIMI frame and IMR. The specificity is 65% for inferring IMR rise with TIMI frame over 40.5. 目的: 探讨冠状动脉(冠脉)微循环阻力在冠脉中度狭窄病变患者的分布特点,心血管危险因素对其影响及冠脉影像特征与其相关性。 方法: 选择冠脉造影狭窄程度在40%~70%患者,行血流储备分数(FFR)、冠脉血流储备(CFR)及微循环阻力指数(IMR)检测,选择FFR>0.75患者,以IMR≥25为临界值将患者分为高IMR组(H组)与低IMR组(N组),以CFR≤2.0为临界值将H组分为高IMR-低CFR组(H1组)与高IMR-高CFR组(H2组)。计数心肌梗死溶栓(TIMI)帧数。 结果: 入组34例,男21例(61.8%),女13例(38.2%),年龄(57.3±8.1)岁,34例患者中47.1%存在高IMR。H组与N组的TIMI(帧)存在明显差别(33.0帧比20.8帧,P=0.031)。H1组与H2组间同型半胱氨酸存在明显差别(17.8 µmol/L比12.0 µmol/L, P=0.005),校正的IMR(IMRcorr)存在明显差别(58.0比36.1,P=0.002)。全部病例IMRcorr与TIMI(帧)相关(r=0.40, P=0.012)。当TIMI(帧)≥40.5帧时,判断IMR≥35.3的敏感度为75%,特异度为65%(P=0.049)。 结论: 高IMR可能是冠脉中度狭窄患者胸痛的原因之一;多数心血管危险因素对IMR及CFR影响不显著;当TIMI(帧)≥40.5时判断冠脉微循环阻力增高的特异度为65%。.
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