背景:心肌桥(MB)伴有心外膜冠状动脉的动态血管外压迫,导致冠状动脉内血流动力学紊乱,冠状动脉血流异常。我们旨在评估电阻储备比(RRR)的预后意义,表示冠状动脉血管舒张能力的流量和压力参数的复合测量,在非阻塞性冠状动脉疾病(ANOCA)和MB的心绞痛患者中,与冠状动脉血流储备(CFR)相比。
结果:在这项回顾性队列研究中,我们纳入了接受冠状动脉反应性测试的ANOCA患者,其中MB是通过收缩期和舒张期之间的冠状动脉节段的短暂收缩来识别的。异常CFR和RRR分别定义为<2.5和<2.62。主要不良心脏事件,包括心血管死亡,中风,心肌梗塞,心力衰竭,和晚期血运重建,作为结果。在1251例ANOCA患者中,191(15.3%)有MB。有和没有MB的患者CFR或RRR异常的患病率没有显着差异(分别为P=0.144和P=0.398)。平均随访时间为6.9年,异常RRR预测MB患者的主要不良心脏事件(风险比[HR],4.38[95%CI,1.71-11.21];P=0.002)和无MB(HR,1.91[95%CI,1.38-2.64];P<0.001)。CFR异常预测无MB患者的主要不良心脏事件(HR,2.15[95%CI,1.54-3.00];P<0.001),而它不能预测MB患者的主要不良心脏事件(HR,2.29[95%CI,0.93-5.65];P=0.073)。
结论:在ANOCA和MB患者中,在区分未来不良事件风险较高的患者方面,受损的RRR优于受损的CFR,提示RRR可作为MB和ANOCA患者的危险分层工具.
BACKGROUND: Myocardial bridging (MB) is accompanied by the dynamic extravascular compression of epicardial coronary arteries, leading to intracoronary hemodynamic disturbance with abnormal coronary flow profiles. We aimed to evaluate the prognostic implications of resistive reserve ratio (RRR), a composite measure of flow and pressure parameters that represents the vasodilatory capacity of the coronary arteries, in patients with angina with nonobstructive coronary artery disease (ANOCA) and MB, in comparison with coronary flow reserve (CFR).
RESULTS: In this retrospective cohort study, we included patients with ANOCA who underwent coronary reactivity testing, where MB was identified by transient constriction in coronary artery segments between systole and diastole. Abnormal CFR and RRR were defined as <2.5 and <2.62, respectively. Major adverse cardiac events, including cardiovascular death, stroke, myocardial infarction, heart failure, and late revascularization, served as outcomes. Among 1251 patients with ANOCA, 191 (15.3%) had MB. The prevalence of abnormal CFR or RRR was not significantly different between patients with and without MB (P=0.144 and P=0.398, respectively). Over a median follow-up time of 6.9 years, abnormal RRR predicted major adverse cardiac events in patients with MB (hazard ratio [HR], 4.38 [95% CI, 1.71-11.21]; P=0.002) and without MB (HR, 1.91 [95% CI, 1.38-2.64]; P<0.001). Abnormal CFR predicted major adverse cardiac events in patients without MB (HR, 2.15 [95% CI, 1.54-3.00]; P<0.001), whereas it was not predictive of major adverse cardiac events in patients with MB (HR, 2.29 [95% CI, 0.93-5.65]; P=0.073).
CONCLUSIONS: In patients with ANOCA and MB, impaired RRR was superior to impaired CFR in distinguishing patients at a higher risk of future adverse events, suggesting that RRR may serve as a risk stratification tool in patients with MB and ANOCA.