背景:有人提出冠状动脉微血管功能随着年龄的增长而降低,无论心外膜动脉粥样硬化的存在。
目的:我们的目的是定量研究年龄对冠状动脉正常患者微血管功能的影响。
方法:在314例无阻塞性冠状动脉疾病(ANOCA)的心绞痛患者中,使用连续热稀释法测试微循环功能。在305名患者中,年龄与静息和高血心肌血流量(Q)之间的关系,微血管阻力(Rμ),评估了绝对冠状动脉血流储备(CFR)和微血管阻力储备(MRR).此外,患者分为3组,以根据年龄四分位数(≤52岁[24.9%],53-64岁[49.2%],≥65岁[25.9%])。
结果:平均年龄为59±9岁,范围为22至79岁。3个年龄组的平均静息Q(Qrest)没有差异(88±34mL/min,82±29mL/min,86±38毫升/分钟,R2=0.001;p=0.62)。随着年龄的增长,观察到平均高血Q(Qmax)下降的趋势(223±79mL/min,209±84mL/min,200±80mL/min,R2=0.010;p=0.083)。平均静息Rμ(Rμ,其余)为1,204±460木材单位(WU),1,260±411WU,和1,289±455WU(p=0.23)。平均高血Rμ(Rμ,hyp)随着年龄的增长而显著增加(429±149WU,464±164WU,503±162WU,R2=0.026;p=0.005)。因此,MRR随年龄增长而降低(3.2±1.2,3.1±1.0,2.9±0.9;p=0.038)。在有(n=121)和没有(n=184)冠状动脉微血管功能障碍(CMD)的患者中均存在这种趋势。
结论:最小微血管阻力和微血管功能下降存在年龄依赖性生理增加,表现为MRR降低,与动脉粥样硬化无关。有和没有CMD的患者都存在MRR的年龄依赖性降低,在冠状动脉光滑的患者中最为明显。
BACKGROUND: It has been suggested that coronary microvascular function decreases with age, irrespective of the presence of epicardial atherosclerosis.
OBJECTIVE: Our aim is to quantitatively investigate the effects of age on microvascular function in patients with normal coronary arteries.
METHODS: In 314 patients with angina with no obstructive coronary artery disease (ANOCA), microcirculatory function was tested using the continuous thermodilution method. In 305 patients, the association between age and both resting and hyperaemic myocardial blood flow (Q), microvascular resistance (Rμ), absolute coronary flow reserve (CFR) and microvascular resistance reserve (MRR) was assessed. In addition, patients were divided into 3 groups to test for differences based on age quartiles (≤52 years [24.9%], 53-64 years [49.2%], ≥65 years [25.9%]).
RESULTS: The mean age was 59±9 years with a range from 22 to 79 years. The mean resting Q (Qrest) was not different in the 3 age groups (88±34 mL/min, 82±29 mL/min, and 86±38 mL/min, R2=0.001; p=0.62). A trend towards a decreasing mean hyperaemic Q (Qmax) was observed with increasing age (223±79 mL/min, 209±84 mL/min, 200±80 mL/min, R2=0.010; p=0.083). The mean resting Rμ (Rμ,rest) were 1,204±460 Wood units (WU), 1,260±411 WU, and 1,289±455 WU (p=0.23). The mean hyperaemic Rμ (Rμ,hyp) increased significantly with advancing age (429±149 WU, 464±164 WU, 503±162 WU, R2=0.026; p=0.005). Consequently, MRR decreased with age (3.2±1.2, 3.1±1.0, 2.9±0.9; p=0.038). This trend was present in both the patients with (n=121) and without (n=184) coronary microvascular dysfunction (CMD).
CONCLUSIONS: There is an age-dependent physiological increase in minimal microvascular resistance and decrease in microvascular function, which is represented by a decreased MRR and is independent of atherosclerosis. The age-dependent decrease in MRR was present in both patients with and without CMD and was most evident in patients with smooth coronary arteries.