医学
蒂米
冠状动脉血流储备
心脏病学
内科学
部分流量储备
溶栓
心肌梗塞
冠状动脉
冠状动脉循环
冠状动脉疾病
动脉
血流
冠状动脉造影
作者
M. Mayer,Tess Allan,Kenneth L. Harkin,Ethan Loftspring,Seyed Ehsan Saffari,Harmony R. Reynolds,Jonathan Paul,Rohan Kalathiya,Atman P. Shah,Sandeep Nathan,Mary C. McCarthy,Nathaniel R. Smilowitz,Steven E.S. Miner,John D. Blair
标识
DOI:10.1016/j.jcin.2024.02.025
摘要
Ischemia with no obstructive coronary arteries is frequently caused by coronary microvascular dysfunction (CMD). Consensus diagnostic criteria for CMD include baseline angiographic slow flow by corrected TIMI (Thrombolysis In Myocardial Infarction) frame count (cTFC), but correlations between slow flow and CMD measured by invasive coronary function testing (CFT) are uncertain. The aim of this study was to investigate relationships between cTFC and invasive CFT for CMD. Adults with ischemia with no obstructive coronary arteries underwent invasive CFT with thermodilution-derived baseline coronary blood flow, coronary flow reserve (CFR), and index of microcirculatory resistance (IMR). CMD was defined as abnormal CFR (<2.5) and/or abnormal IMR (≥25). cTFC was measured from baseline angiography; slow flow was defined as cTFC >25. Correlations between cTFC and baseline coronary flow and between CFR and IMR and associations between slow flow and invasive measures of CMD were evaluated, adjusted for covariates. All patients provided consent. Among 508 adults, 49% had coronary slow flow. Patients with slow flow were more likely to have abnormal IMR (36% vs 26%; P = 0.019) but less likely to have abnormal CFR (28% vs 42%; P = 0.001), with no difference in CMD (46% vs 51%). cTFC was weakly correlated with baseline coronary blood flow (r = −0.35; 95% CI: −0.42 to −0.27), CFR (r = 0.20; 95% CI: 0.12 to 0.28), and IMR (r = 0.16; 95% CI: 0.07-0.24). In multivariable models, slow flow was associated with lower odds of abnormal CFR (adjusted OR: 0.53; 95% CI: 0.35 to 0.80). Coronary slow flow was weakly associated with results of invasive CFT and should not be used as a surrogate for the invasive diagnosis of CMD.
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