Coronary vasomotor dysfunction (CVDys) can be comprehensively classified on the basis of anatomy and functional mechanisms. The aim of this study was to evaluate the association between different CVDys phenotypes and outcomes in patients with angina and nonobstructive coronary artery disease (ANOCA). Patients with ANOCA who underwent coronary reactivity testing using an intracoronary Doppler guidewire to assess microvascular and epicardial coronary endothelium-dependent and endothelium-independent function were enrolled. Endothelium-dependent microvascular and epicardial coronary dysfunction were defined as a <50% change in coronary blood flow in response to intracoronary acetylcholine (Ach) infusion and a <−20% change in coronary artery diameter in response to Ach. Endothelium-independent microvascular and epicardial coronary dysfunction were defined as coronary flow reserve < 2.5 during adenosine-induced hyperemia and change in cross-sectional area in response to intracoronary nitroglycerin administration < 20%. Major adverse cardiac and cerebrovascular events (cardiovascular death, nonfatal MI, heart failure, stroke, and late revascularization) served as clinical outcomes. Among the 1,196 patients with ANOCA, the prevalence of CVDys was 24.5% and 51.8% among those with endothelium-independent and endothelium-dependent microvascular dysfunction, respectively, and 47.4% and 25.4% among those with endothelium-independent and endothelium-dependent epicardial coronary dysfunction, respectively. During 6.3 years (Q1-Q3: 2.5-12.9 years) of follow-up, patients with endothelium-dependent microvascular dysfunction, endothelium-dependent epicardial coronary dysfunction, or endothelium-independent microvascular dysfunction showed significantly higher event rates compared with those without (19.5% vs 12.0% [ < 0.001], 19.7% vs 14.6% [ = 0.038] and 22.2% vs 13.8% [ = 0.001], respectively). Coronary flow reserve (HR: 0.757; 95% CI: 0.604-0.957) and percentage change in coronary blood flow in response to Ach infusion (HR: 0.998; 95% CI: 0.996-0.999) remained significant predictors of major adverse cardiac and cerebrovascular event after adjustment for conventional risk factors. CVDys phenotype is differentially associated with worse outcomes, and endothelium-dependent and endothelium-independent microvascular function provide independent prognostic information in patients with ANOCA.

中文翻译：

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冠状动脉血管舒缩功能障碍与非阻塞性冠状动脉疾病患者的心血管事件相关

冠状动脉血管舒缩功能障碍（CVDys）可以根据解剖学和功能机制进行全面分类。本研究的目的是评估不同 CVDys 表型与心绞痛和非阻塞性冠状动脉疾病 (ANOCA) 患者结局之间的关联。患有 ANOCA 的患者使用冠状动脉内多普勒导丝进行冠状动脉反应性测试，以评估微血管和心外膜冠状动脉内皮依赖性和内皮依赖性功能。内皮依赖性微血管和心外膜冠状动脉功能障碍被定义为响应冠状动脉内乙酰胆碱（Ach）输注的冠状动脉血流量变化<50％，以及响应Ach的冠状动脉直径变化<−20％。不依赖于内皮的微血管和心外膜冠状动脉功能障碍定义为腺苷引起的充血期间冠状动脉血流储备<2.5，以及冠状动脉内给予硝酸甘油后横截面积的变化<20%。主要不良心脑血管事件（心血管死亡、非致命性心肌梗死、心力衰竭、中风和晚期血运重建）作为临床结局。在 1,196 名 ANOCA 患者中，内皮非依赖性和内皮依赖性微血管功能障碍患者中 CVDys 的患病率分别为 24.5% 和 51.8%，内皮非依赖性和内皮依赖性心外膜冠状动脉患者中 CVDys 的患病率分别为 47.4% 和 25.4%功能障碍，分别。在 6.3 年（Q1-Q3：2.5-12.9 年）的随访期间，内皮依赖性微血管功能障碍、内皮依赖性心外膜冠状动脉功能障碍或内皮非依赖性微血管功能障碍患者的事件发生率显着高于无内皮依赖性微血管功能障碍的患者（19.5分别为 % vs 12.0% [ < 0.001]、19.7% vs 14.6% [ = 0.038] 和 22.2% vs 13.8% [ = 0.001]。冠状动脉血流储备（HR：0.757；95% CI：0.604-0.957）和乙酰胆碱输注后冠脉血流的百分比变化（HR：0.998；95% CI：0.996-0.999）仍然是主要不良心脑血管的重要预测因素。调整常规风险因素后的事件。 CVDys 表型与较差的预后存在差异相关，内皮依赖性和内皮非依赖性微血管功能为 ANOCA 患者提供独立的预后信息。