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心血管疾病是全世界病死率最高的疾病之一[1]。在过去的数十年,男性心血管疾病的发病率不断下降,而女性的发病率却呈上升趋势[1-2],且病死人数超过男性[2-3],这与女性的冠状动脉(冠脉)病理生理基础、自主神经状态及雌激素水平等相关。女性冠心病(coronary artery disease, CAD)患者多表现为非阻塞性冠脉微循环功能障碍[4-5],存在发生主要不良心血管事件(major adverse cardiovascular events, MACE)的风险[6-9]。并且,女性CAD患者常伴有交感神经活动增加[10],导致心输出量及心肌耗氧量增加,也会增加其发生MACE的风险。
核素心肌灌注显像(myocardial perfusion imaging, MPI)血流绝对定量技术能够灵敏地检测静息及负荷状态下的心肌血流量(myocardial blood flow, MBF),获得冠脉血流储备(coronary flow reserve, CFR),提高对CAD的诊断效能[11-13]。在传统MPI正常的女性胸痛患者中,非阻塞性冠脉微循环功能障碍的检出率为54%[14]。此外,由于心脏交感神经分子影像技术复杂、成本较高,在临床应用中受限,而MPI检查过程中心率和血压的变化,近年来被报道可以作为自主神经功能的替代指标,用于CAD患者的风险评估[15-17]。在此背景下,本文通过负荷MPI中心率和血压的变化对血流灌注及MACE的预测价值进行综述,希望为进一步推进负荷MPI对女性CAD患者的诊断及风险评估提供指导,为制定以改善女性自主神经功能为靶点的诊治策略提供信息。
负荷心肌灌注显像中心率和血压变化预测女性心血管事件的研究进展
Research progress of heart rate and blood pressure changes in stress myocardial perfusion imaging for predicting female cardiovascular events
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摘要: 女性相比男性具有不同的冠状动脉(冠脉)解剖生理基础及神经激素水平,这导致其更多表现为非阻塞性冠脉微循环功能障碍。核素心肌灌注显像(MPI)血流绝对定量技术是一种无创性诊断冠心病(CAD)并对其进行风险评估的功能性检查方法。负荷试验中的心率和血压变化作为自主神经功能的替代指标,对女性血流灌注参数乃至不良心血管事件有一定的预测作用。笔者就负荷MPI中心率和血压变化对CAD诊断及风险评估的增益价值进行综述,为推进负荷MPI的临床应用及制定用以改善女性自主神经功能为靶点的诊疗方案提供依据。Abstract: Compared with men, women have different anatomical and physiological basis of coronary artery and neurohormone levels, resulting in more often from non-obstructive coronary microvascular dysfunction. Absolute quantitative myocardial perfusion imaging (MPI) is a noninvasive functional examination, which increases diagnosis performance, treatment evaluation, and prognostic evaluation of coronary artery disease (CAD). The change of heart rate and blood pressure in stress test, as the alternative indicator of autonomic nerve function, has a role in predicting blood perfusion parameters and adverse cardiovascular events. This review summarizes the gain value of stress MPI heart rate and blood pressure change on CAD diagnosis and risk assessment, so as to provide a basis for promoting the clinical application of stress MPI and formulating a diagnosis and treatment plan aimed to improving female autonomic nerve function.
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