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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。
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