caIMR、CMR对冠脉微循环障碍评估的对比分析及心脑微血管病变相关性研究OA
Comparative Analysis of caIMR and CMR in Assessing Coronary Microvascular Dysfunction and Correlation of Cardiac and Cerebral Microvascular Lesions
目的 通过心脏磁共振评估基于冠状动脉造影的微循环阻力指数对于冠状动脉微循环障碍的诊断效能,并进一步探究冠状动脉微循环障碍与无症状脑梗死间的相关性.方法 选取 2021 年 1 月至 2024 年 12月期间就诊于昆明医科大学第二附属医院心血管内科的患者 231 例.通过FlashAngio系统对冠状动脉造影图像左前降支血管进行分析得出caIMR值,以 25 为界限分为冠状动脉微循环正常组(caIMR<25,n=126)和冠状动脉微循环障碍组(caIMR≥25,n=105).收集所有患者的一般临床资料、实验室指标(血常规、生化全套、糖化血红蛋白)、颅脑CT/MRI结果、心肌微循环磁共振灌注参数(达峰时间(tpeak)、相对峰值信号强度(RSIpeak)、最大上升斜率(Slopemax))、经胸超声心动图常规参数.结果 (1)50 例同时完善CMR和caIMR的患者,caIMR≥25 组左前降支支配区域出现了不同程度的tpeak延长,RSIpeak和Slopemax降低,表明caIMR≥25 组存在冠状动脉微循环障碍.进行Cohen's Kappa检验一致性分析,Kappa值 0.839(P<0.05),表明caIMR对于CMD的识别具有较高的准确度和评价效果;(2)127 例糖尿病患者按照糖化血红蛋白(HbA1c)水平分为血糖控制良好组(4%≤HbA1c<6%)、血糖控制不佳组(6%≤HbA1c<8%)、血糖控制差组(HbA1c≥8%).40 例血糖控制良好组、59 例血糖控制不佳组及 28 例血糖控制差组患者对比,血糖控制不佳组和血糖控制差组caIMR值中位数均高于血糖控制良好组(P<0.05),且血糖控制不佳组caIMR中位数 24.60 接近于诊断冠状动脉微循环障碍的caIMR分界值 25,血糖控制差组caIMR中位数 32.15 远高于分界值 25;(3)在冠状动脉微循环障碍组中发现很多患者同时存在无症状脑梗死,而在冠状动脉微循环正常组患者中则较少,差异具有统计学意义(P<0.05).进一步进行Phi系数相关性分析,Phi系数 0.562,差异具有统计学意义(P<0.001).提示冠状动脉微循环障碍与无症状脑梗死之间存在相关性.结论 caIMR对于冠状动脉微循环功能障碍的识别具有较高准确度,且与心脏磁共振的评估效能一致性较高,而在冠状动脉微循环障碍的患者中发现大多同时存在无症状脑梗死,说明心脑微血管两者之间的病变发展可能存在相关性.
Objective To evaluate the diagnostic efficacy of coronary angiography-based microcirculatory resistance index for coronary microcirculatory dysfunction through cardiac magnetic resonance(CMR),and further explore the correlation between coronary microcirculatory dysfunction and silent cerebral infarction.Methods 231 patients from the Cardiovasology Department of the Second Affiliated Hospital of Kunming Medical University between January 2021 and December 2024 were selected.The caIMR value of the left anterior descending coronary artery was analyzed using the FlashAngio system,with patients divided into normal coronary microcirculation group(caIMR<25,n=126)and coronary microcirculatory dysfunction group(caIMR≥25,n=105).General clinical data,laboratory indicators(complete blood count,biochemical panel,glycated hemoglobin),cranial CT/MRI results,cardiac microcirculatory perfusion MRI parameters(time to peak[tpeak],relative signal intensity at peak[RSIpeak],maximum upslope[Slopemax]),and routine transthoracic echocardiography parameters of all patients were collected.Results(1)Among 50 patients who completed both CMR and caIMR,the caIMR≥25 group showed varying degrees of tpeak prolongation,with reduced RSIpeak and Slopemax,indicating coronary microcirculatory dysfunction.Cohen's Kappa consistency analysis showed a Kappa value of 0.839(P<0.05),suggesting high accuracy of caIMR in identifying CMD;(2)127 diabetic patients were categorized based on HbA1c levels into good glycemic control group(4%≤HbA1c<6%),moderate glycemic control group(6%≤HbA1c<8%),and poor glycemic control group(HbA1c≥8%).Comparing 40 patients in the good control group,59 in the moderate control group,and 28 in the poor control group,the median caIMR values in the moderate and poor control groups were higher than the good control group(P<0.05).The moderate control group's median caIMR of 24.60 was close to the diagnostic threshold of 25,while the poor control group's median caIMR of 32.15 was significantly higher;(3)In the coronary microcirculatory dysfunction group,several patients simultaneously had silent cerebral infarction,which was less common in the normal microcirculation group,with statistically significant difference(P<0.05).Further Phi coefficient correlation analysis showed a coefficient of 0.562,with statistically significant difference(P<0.001),suggesting a correlation between coronary microcirculatory dysfunction and silent cerebral infarction.Conclusion caIMR demonstrates high accuracy in identifying coronary microcirculatory dysfunction,with good consistency with CMR assessment.The high prevalence of silent cerebral infarction in patients with coronary microcirculatory dysfunction suggests potential interconnected pathological development in cerebral and cardiac microvascular systems.
虞敏;孙林
昆明医科大学第二附属医院心血管内科,云南 昆明 650101昆明医科大学第二附属医院心血管内科,云南 昆明 650101
医药卫生
caIMR心脏磁共振冠状动脉微循环障碍无症状脑梗死
CaIMRCoronary microvascular diseaseCardiac magnetic resonanceSilent brain infarction
《昆明医科大学学报》 2026 (2)
68-82,15
云南省"心脑同治"临床医学关键新技术研发项目(202203AC100007)
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