Background

Microvascular resistance (MR) is increased in takotsubo syndrome (TTS) and can be assessed by a validated pressure-wire-free tool called nonhyperemic angiography-derived index of microcirculatory resistance (NH-IMRangio).

Objectives

The authors aimed to study whether the degree and extent of an altered MR in TTS patients were associated with 1-year prognosis.

Methods

The authors recruited 181 consecutive patients with TTS who underwent cardiac angiography. Impaired MR was defined as an NH-IMRangio ≥25. The degree and extent of impaired MR were assessed by the value of maximum NH-IMRangio in each major coronary artery and by the number of coronary arteries with an NH-IMRangio ≥25, respectively. Major adverse cardiac events (MACE) were a composite of cardiovascular death, heart failure event, acute myocardial infarction, and hospitalization for symptomatic arrhythmias.

Results

A total of 166 patients had NH-IMRangio available. The mean age was 74.8 years, and 83% were women. The rate of MACE at 1 year was 21.1%, mainly due to heart failure events that were generally mild. Kaplan-Meier curves showed higher rates of MACE in patients with higher NH-IMRangio (28.9% vs 13.3%; P = 0.019) and in those with 3 coronary arteries with increased MR compared to those with 2 or 1 affected arteries (33.3% vs 15.9% vs 9.5%; P = 0.040 and P = 0.040, respectively). After a multivariable Cox regression analysis, higher values of NH-IMRangio (HR: 3.41 [95% CI: 1.54-7.52]; P = 0.002) and the presence of 3 coronary arteries with increased MR (HR: 6.39 [95% CI: 1.46-27.87]; P = 0.014) were independent predictors of MACE in TTS patients.

Conclusions

The degree and extent of an impaired MR assessed by a validated pressure-wire-free tool were independent predictors of MACE at 1-year follow-up in TTS patients.

中文翻译：

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Takotsubo综合征患者静息时微血管阻力的预后价值

背景

takotsubo 综合征 (TTS) 中的微血管阻力 (MR) 增加，并且可以通过称为非充血血管造影衍生的微循环阻力指数 (NH-IMRangio) 的经过验证的无压力工具进行评估。

目标

作者旨在研究 TTS 患者 MR 改变的程度和程度是否与 1 年预后相关。

方法

作者连续招募了 181 名接受心脏血管造影的 TTS 患者。受损的 MR 定义为 NH-IMRangio ≥25。MR受损的程度和程度分别通过每个主要冠状动脉的最大NH-IMRangio值和NH-IMRangio≥25的冠状动脉数量来评估。主要不良心脏事件（MACE）是心血管死亡、心力衰竭事件、急性心肌梗死和因症状性心律失常住院的复合事件。

结果

共有 166 名患者有可用的 NH-IMRangio。平均年龄为 74.8 岁，83% 为女性。1 年 MACE 发生率为 21.1%，主要是由于心力衰竭事件一般较轻。Kaplan-Meier 曲线显示，NH-IMRangio 较高的患者（28.9% vs 13.3%；P = 0.019）和 3 支冠状动脉 MR 增加的患者与 2 或 1 支受累动脉的患者相比，MACE 发生率更高（33.3% vs 15.9% 对 9.5%；分别为P = 0.040 和P = 0.040）。多变量 Cox 回归分析后，NH-IMRangio 值较高（HR：3.41 [95% CI：1.54-7.52]；P = 0.002）和 3 支冠状动脉的 MR 增加（HR：6.39 [95% CI： 1.46-27.87]；P =0.014) 是 TTS 患者 MACE 的独立预测因子。

结论

通过经过验证的无压力工具评估的 MR 受损程度和程度是 TTS 患者 1 年随访时 MACE 的独立预测因素。