非冠状动脉梗阻性缺血性心脏病女性患者心率储备与微循环功能障碍的相关性研究

目的探讨非冠状动脉梗阻性缺血性心脏病（INOCA）女性患者在药物负荷状态下心率变化与冠状动脉血流速度储备（CFVR）之间的相关性。 方法本研究为单中心回顾性研究。连续选取2018年11月至2020年11月疑似心绞痛来辽宁省人民医院就诊且3个月内行冠状动脉造影检查狭窄直径＜50%，并在辽宁省人民医院接受经胸腺苷负荷试验超声心动图检查的60例女性患者。收集患者的临床资料、常规超声心动图参数、腺苷负荷前后血流动力学参数以及CFVR结果，根据CFVR分为微循环功能障碍（CMD）组（CFVR＜2）26例和对照组（CFVR≥2）34例。比较2组患者的临床特征、超声心动图参数及血流动力学参数，采用相关性分析评估CFVR与各变量间的线性相关性，采用多元线性回归分析CFVR相关的危险因素。 结果单因素分析结果显示，CMD组年龄、收缩压峰值和舒张压峰值、静息心率以及糖尿病、高血压、高血脂所占比例均高于对照组，心率储备（HRR）CMD组低于对照组，差异均有统计学意义（P均＜0.05）。相关性分析显示，CFVR与HRR呈中等程度正相关（r=0.490，P＜0.001），与年龄（r=-0.390，P＜0.05）、高血脂（r=-0.312，P＜0.05）、基线心率（r=-0.327，P＜0.05）呈弱的负相关。多元线性回归分析显示，HRR是CFVR的独立影响因素（β=0.391，P＜0.05）。ROC曲线显示，HRR预测CMD的曲线下面积为0.85（P＜0.001），HRR=35%为最佳截断值，其预测CMD的敏感度和特异度分别为71%和88%。 结论HRR与INOCA女性患者异常CFVR相关，其可能有助于INOCA患者CMD的危险分层。

Correlation between heart rate reserve and microcirculatory dysfunction in female patients with non-coronary obstructive ischemic heart disease

ObjectiveTo explore the relationship between heart rate variability and coronary flow velocity reserve (CFVR) during adenosine infusion in female patients with non-obstructive coronary artery disease. MethodsThis was a single-center retrospective study. Consecutive female patients with suspected angina presenting to People's Hospital of Liaoning Province with stenosis diameter ＜50% on coronary angiography within 3 months and undergoing transthoracic echocardiography at our hospital from November 2018 to November 2020 were selected. Clinical data, conventional echocardiographic parameters, hemodynamic parameters before and after adenosine infusion, and CFVR results were collected, and the patients were divided into either a case group (CFVR＜2) or a control group (CFVR≥2) according to CFVR. The clinical characteristics of patients in the two groups were compared, and linear correlation between CFVR and each variable was assessed using correlation analysis, and multiple linear regression analysis was used to explore the risk factors associated with microcirculatory dysfunction (CMD). ResultsA total of 60 female patients were included. Univariate analysis showed that age, peak systolic and diastolic blood pressure, resting heart rate, proportion of diabetes mellitus, proportion of hypertension, and proportion of hyperlipidemia were significantly higher, and heart rate reserve (HRR) was significantly lower in the CMD group than in the control group (P＜0.05). Correlation analysis showed that CFVR was moderately positively correlated with HRR (r=0.490, P＜0.001) and weakly negatively correlated with age (r=-0.390, P＜0.05), hyperlipidemia (r=-0.312, P＜0.05), and baseline heart rate (r=-0.327, P＜0.05). Multiple linear regression analysis showed that CFVR remained independently correlated with HRR after adjusting for hypertension, diabetes, hyperlipidemia, age, peak diastolic blood pressure, peak systolic blood pressure, and baseline heart rate (β=0.391, P＜0.05). ROC curve analysis showed that the area under the curve of HRR for prediction of CMD was 0.85 (P＜0.001), and 35% was the best cut-off value of HRR, with a sensitivity and specificity of 71% and 88%, respectively. ConclusionHRR is associated with abnormal CFVR in female patients with nonobstructive coronary artery disease and may contribute to risk stratification of CMD in such patients.