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

doi:10.3877/cma.j.issn.1672-6448.2022.10.010

中华医学超声杂志（电子版） ›› 2022, Vol. 19 ›› Issue (10) : 1077 -1082. doi: 10.3877/cma.j.issn.1672-6448.2022.10.010

心血管超声影像学

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

刘婷婷¹, 丁明岩², 冀威², 郭丽娟², 李颖², 赵含章², 朱芳²^,^†(

)

^1. 116044　大连医科大学研究生院影像医学与核医学系；110016　沈阳，辽宁省人民医院心功能科
^2. 110016　沈阳，辽宁省人民医院心功能科

收稿日期:2021-04-23 出版日期:2022-10-01
通信作者: 朱芳
基金资助:
辽宁省科学基金项目(20180530109)

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

Tingting Liu¹, Mingyan Ding², Wei Ji², Lijuan Guo², Ying Li², Hanzhang Zhao², Fang Zhu²^,^†()

^1. Faculty of Medical Imaging and Nuclear Medicine, Graduate School of Dalian Medical University, Dalian 116044, Liaoning Province, China; Department of Cardiac Function, People's Hospital of Liaoning Province, Shenyang 110016, Liaoning Province, China
^2. Department of Cardiac Function, People's Hospital of Liaoning Province, Shenyang 110016, Liaoning Province, China

Received:2021-04-23 Published:2022-10-01
Corresponding author: Fang Zhu

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引用本文：

刘婷婷, 丁明岩, 冀威, 郭丽娟, 李颖, 赵含章, 朱芳. 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[J]. 中华医学超声杂志（电子版）, 2022, 19(10): 1077-1082.

Tingting Liu, Mingyan Ding, Wei Ji, Lijuan Guo, Ying Li, Hanzhang Zhao, Fang Zhu. Correlation between heart rate reserve and microcirculatory dysfunction in female patients with non-coronary obstructive ischemic heart disease[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(10): 1077-1082.

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。

关键词: 超声心动描记术, 心肌缺血, 冠状动脉微循环功能障碍, 冠状动脉血流速度储备, 心率储备, 腺苷

Objective

To 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.

Methods

This 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).

Results

A 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.

Conclusion

HRR is associated with abnormal CFVR in female patients with nonobstructive coronary artery disease and may contribute to risk stratification of CMD in such patients.

Key words: Echocardiography, Myocardial ischemia, Coronary microcirculatory dysfunction, Coronary flow velocity reserve, Heart rate reserve, Adenosine

表1 CMD组与对照组一般临床资料比较

一般资料	CMD组（n=26）	对照组（n=34）	统计值	P值
高血压［例（%）］	16（61.5）	11（32.4）	χ²=5.071	0.024
糖尿病［例（%）］	11（42.3）	6（52.9）	χ²=4.413	0.036
高血脂［例（%）］	15（57.7）	10（29.4）	χ²=4.848	0.028
吸烟［例（%）］	3（11.5）	3（8.8）	χ²=0.121	0.728
年龄（岁， $x ¯$ ±s）	61.38±9.88	51.79±11.70	t=3.359	0.001
BMI（kg/m²， $x ¯$ ±s）	23.91±2.02	23.58±2.25	t=0.598	0.552

表1 CMD组与对照组一般临床资料比较

一般资料	CMD组（n=26）	对照组（n=34）	统计值	P值
高血压［例（%）］	16（61.5）	11（32.4）	χ²=5.071	0.024
糖尿病［例（%）］	11（42.3）	6（52.9）	χ²=4.413	0.036
高血脂［例（%）］	15（57.7）	10（29.4）	χ²=4.848	0.028
吸烟［例（%）］	3（11.5）	3（8.8）	χ²=0.121	0.728
年龄（岁， $x ¯$ ±s）	61.38±9.88	51.79±11.70	t=3.359	0.001
BMI（kg/m²， $x ¯$ ±s）	23.91±2.02	23.58±2.25	t=0.598	0.552

表2 CMD组与对照组超声心动图参数及血流动力学参数比较（

x ˉ

±s）

参数	CMD组（n=26）	对照组（n=34）	t值	P值
LVEF	58.46±2.21	59.35±2.03	-1.622	0.110
舒张压基线（mmHg）	76.46±10.95	72.06±11.40	1.508	0.137
舒张压峰值（mmHg）	74.50±11.75	68.24±10.84	2.139	0.037
收缩压基线（mmHg）	133.50±18.75	126.68±16.35	1.503	0.138
收缩压峰值（mmHg）	136.38±14.27	125.59±22.53	2.135	0.037
基线心率（次/分）	75.35±7.22	70.94±7.68	2.258	0.028
峰值心率（次/分）	93.27±8.01	98.47±9.22	-1.410	0.164
心率储备（%）	25.77±7.87	39.41±10.62	-5.493	＜0.001
E峰（cm/s）	75.46±17.38	75.15±19.48	0.065	0.948
A峰（cm/s）	83.46±19.17	80.71±16.66	0.595	0.554
E/A	0.95±0.33	0.98±0.32	-0.256	0.799
LVMI（g/m²）	70.73±7.42	72.35±5.78	-0.900	0.372

表2 CMD组与对照组超声心动图参数及血流动力学参数比较（

x ˉ

±s）

参数	CMD组（n=26）	对照组（n=34）	t值	P值
LVEF	58.46±2.21	59.35±2.03	-1.622	0.110
舒张压基线（mmHg）	76.46±10.95	72.06±11.40	1.508	0.137
舒张压峰值（mmHg）	74.50±11.75	68.24±10.84	2.139	0.037
收缩压基线（mmHg）	133.50±18.75	126.68±16.35	1.503	0.138
收缩压峰值（mmHg）	136.38±14.27	125.59±22.53	2.135	0.037
基线心率（次/分）	75.35±7.22	70.94±7.68	2.258	0.028
峰值心率（次/分）	93.27±8.01	98.47±9.22	-1.410	0.164
心率储备（%）	25.77±7.87	39.41±10.62	-5.493	＜0.001
E峰（cm/s）	75.46±17.38	75.15±19.48	0.065	0.948
A峰（cm/s）	83.46±19.17	80.71±16.66	0.595	0.554
E/A	0.95±0.33	0.98±0.32	-0.256	0.799
LVMI（g/m²）	70.73±7.42	72.35±5.78	-0.900	0.372

图1 冠状动脉血流速度储备与心率储备的相关性分析散点图注：CFVR为冠状动脉血流速度储备；HRR为心率储备

表3 CFVR与临床资料及血流动力学参数的相关性分析及多元线性回归分析

变量	相关性分析		多元线性回归分析
变量	r值	P值	β值	P值
高血压	-0.188	0.151	-0.004	0.978
糖尿病	-0.235	0.071	-0.021	0.867
高血脂	-0.312	0.015	-0.174	0.161
年龄	-0.390	0.002	-0.159	0.249
舒张压峰值	-0.241	0.063	-0.166	0.191
收缩压峰值	-0.095	0.468	0.010	0.936
基线心率	-0.327	0.011	-0.028	0.845
心率储备	0.490	＜0.001	0.391	0.013

表3 CFVR与临床资料及血流动力学参数的相关性分析及多元线性回归分析

变量	相关性分析		多元线性回归分析
变量	r值	P值	β值	P值
高血压	-0.188	0.151	-0.004	0.978
糖尿病	-0.235	0.071	-0.021	0.867
高血脂	-0.312	0.015	-0.174	0.161
年龄	-0.390	0.002	-0.159	0.249
舒张压峰值	-0.241	0.063	-0.166	0.191
收缩压峰值	-0.095	0.468	0.010	0.936
基线心率	-0.327	0.011	-0.028	0.845
心率储备	0.490	＜0.001	0.391	0.013

图2 心率储备预测微循环功能障碍的ROC曲线

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

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