Assessment of clinical characteristics of coronary microvascular dysfunction in elderly patients with chest pain by dynamic 99m Tc-sestamibi CZT-SPECT camera
Objective Coronary microvascular dysfunction(CMVD)often mediates abnormal expansion of non-endo-thelial dependent microvessels and causes ischemia and angina pectoris.For cardiovascular diseases without epicardial coronary artery stenosis,microvascular lesions play a very important role and are related to the increase in cardiovascular events.Coro-nary flow reserve(CFR)is one of the most sensitive parameters to detect the early signs of coronary atherosclerosis at the mi-crovascular level.The new dynamic 99m Tc-sestamibi CZT-SPECT for evaluating CFR has emerged as a promising technique for determination of CMVD.We aimed to describe the prevalence,clinical features,and prognosis of CMVD in patients with chest pain by coronary angiography and dynamic CZT-SPECT.Methods A total of 298 elderly patients(aged≥60 years)who were hospitalized in Huadong Hospital due to chest pain from January 2020 to January 2022 were selected.They all underwent coronary angiography and rest/stress dynamic and routine gated myocardial perfusion imaging(MPI).At the vascular level,if any coronary artery stenosis＜50%and CFR＜2,it was considered CMVD.At the patient level,CMVD was considered a type of non-obstructive coronary artery disease(CAD).The medical history,biochemical indicators,and other information of the patients were collected.The follow-up was conducted until June.30,2023.The major adverse cardiovascular event(MACE)was defined as readmission due to chest tightness and pain,acute coronary syndrome(ACS)and death.Results 73.5%of the patients had angina,but their coronary angiography was negative.30.9%of patients with non-obstructive CAD had CM-VD.In non-obstructive CAD patients,the incidence of MACE in the CFR＜2 group was higher than that in the CFR≥2 group(P＜0.001).Logistic regression analysis found that diabetes(β 1.837,OR 6.227,95%CI 3.071-12.831,P＜0.001),coro-nary slow flow(CSF)(β 1.150,OR 3.157,95%CI 1.341-7.434,P =0.009)and hyperlipidemia(β 0.832,OR 2.297,95%CI1.052-5.016,P =0.037)were important predictors of CMVD.Conclusion Among non-obstructive CAD patients,CMVD patients have a higher incidence of MACE.Diabetes,hyperlipidemia and CSF are independent predictors of CMVD.Quantitative CFR detection by dynamic 99m Tc-sestamibi CZT-SPECT is technically feasible and can reflect coronary microvascu-lar function.
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