Quantification of Myocardial Blood Flow
Exploring risk factors for combined coronary microvascular dysfunction in patients with ischemia and non-obstructive coronary artery disease
Zhang Han, Fan Xin, Huang Yan, Hu Xueping, Qin Shanshan, Sun Ming, Cai Haidong, Yu Fei
Published 2023-03-25
Cite as Chin J Nucl Med Mol Imaging, 2023, 43(3): 139-143. DOI: 10.3760/cma.j.cn321828-20220907-00283
Abstract
ObjectiveTo investigate the risk factors for combined coronary microvascular dysfunction (CMD) in patients with ischemia and non-obstructive coronary artery disease (INOCA).
MethodsFrom October 2020 to May 2022, 100 INOCA patients with myocardial ischemic symptoms who underwent coronary angiography (CAG) suggestive of <50% stenosis in all three coronary arteries at the Tenth People′s Hospital of Tongji University were prospectively recruited. Myocardial perfusion imaging (MPI), transthoracic echocardiography and cadmium-zinc-telluride (CZT) SPECT coronary flow quantification were performed in the same month, and 93 INOCA patients (36 males and 57 females, age (63.0±10.9) years) were finally included. CMD was defined as coronary flow reserve (CFR)<2.5. Independent-sample t test, Mann-Whitney U test and χ2 test were used to compare MPI results and left ventricular volume parameters between CMD and non-CMD groups. ROC curve analysis was used to analyze the efficacy of each index in predicting CMD, and independent risk factors for CMD were screened by multivariate logistic regression analysis.
ResultsAmong 93 INOCA patients, 29 were in the CMD group and 64 were in the non-CMD group. The age, proportion of hypertension, left ventricular mass index (LVMI), summed stress score (SSS), summed difference score (SDS), left ventricular internal diameter systolic (LVIDS), interventricular septum thickness (IVST), and left ventricular posterior wall thickness (LVPWT) in the CMD group were higher than those in the non-CMD group (t values: 2.42-3.76, χ2=8.94, z values: -3.31, -3.41, all P<0.05). ROC curve analysis showed that LVMI, SSS, SDS, LVPWT, IVST and age were significant in predicting CMD (AUCs: 0.67-0.72). Multivariate logistic regression analysis showed that LVMI (odds ratio (OR)=1.08, 95% CI: 1.01-1.17), SDS (OR=5.37, 95% CI: 1.95-14.78), hypertension (OR=5.68, 95% CI: 1.34-24.18) and age (OR=1.10, 95% CI: 1.03-1.18) were risk factors for CMD.
ConclusionLVMI, SDS, hypertension and age are strongly associated with combined CMD in INOCA patients, which can be used for early risk stratification of INOCA patients.
Key words:
Coronary artery disease; Myocardial ischemia; Coronary circulation; Myocardial perfusion imaging; Coronary angiography; Tomography, emission-computed, single-photon; Echocardiography; Risk factors
Contributor Information
Zhang Han
Department of Nuclear Medicine, Tenth People′s Hospital of Tongji University, Tongji University School of Medicine
Institute of Nuclear Medicine, Tongji University School of Medicine, Shanghai 200072, China
Fan Xin
Department of Nuclear Medicine, Tenth People′s Hospital of Tongji University, Tongji University School of Medicine
Institute of Nuclear Medicine, Tongji University School of Medicine, Shanghai 200072, China
Huang Yan
Department of Nuclear Medicine, Tenth People′s Hospital of Tongji University, Tongji University School of Medicine
Institute of Nuclear Medicine, Tongji University School of Medicine, Shanghai 200072, China
Hu Xueping
Department of Nuclear Medicine, Tenth People′s Hospital of Tongji University, Tongji University School of Medicine
Institute of Nuclear Medicine, Tongji University School of Medicine, Shanghai 200072, China
Qin Shanshan
Department of Nuclear Medicine, Tenth People′s Hospital of Tongji University, Tongji University School of Medicine
Institute of Nuclear Medicine, Tongji University School of Medicine, Shanghai 200072, China
Sun Ming
Department of Nuclear Medicine, Tenth People′s Hospital of Tongji University, Tongji University School of Medicine
Institute of Nuclear Medicine, Tongji University School of Medicine, Shanghai 200072, China
Cai Haidong
Department of Nuclear Medicine, Tenth People′s Hospital of Tongji University, Tongji University School of Medicine
Institute of Nuclear Medicine, Tongji University School of Medicine, Shanghai 200072, China
Yu Fei
Department of Nuclear Medicine, Tenth People′s Hospital of Tongji University, Tongji University School of Medicine
Institute of Nuclear Medicine, Tongji University School of Medicine, Shanghai 200072, China