Background:Coronary function testing in patients with ischemia and nonobstructive coronary arteries (INOCA) commonly includes assessment of adenosine-mediated vasodilation and acetylcholine spasm provocation. The purpose of this study was to evaluate the diagnostic value of additional endothelial function testing for the diagnosis of vasomotor dysfunction in patients with INOCA.Methods:In this retrospective cohort study, we included patients with INOCA who underwent clinically indicated comprehensive coronary function testing. Endothelial dysfunction was defined as a <50% increase in coronary blood flow, determined by Doppler flow, and/or epicardial vasoconstriction compared to baseline, in response to low-dose acetylcholine. Coronary artery spasm (CAS) was defined as vasospastic angina or microvascular angina in response to coronary high-dose acetylcholine. An impaired adenosine-mediated vasodilation was defined as a coronary flow reserve <2.5 and/or hyperemic microvascular resistance ≥2.5.Results:Among all 110 patients, 79% had endothelial dysfunction, 62% had CAS, and 29% had an impaired adenosine-mediated vasodilation. Endothelial dysfunction was present in 80% of patients who tested positively for CAS and/or an impaired adenosine-mediated vasodilation. Endothelial function testing increases the diagnostic yield of coronary function testing that only incorporates adenosine testing and spasm provocation by 17% to 92%. Of patients with normal adenosine-mediated vasodilation and no inducible CAS, 68% had endothelial dysfunction.Conclusions:Concomitant endothelial dysfunction was prevalent in the vast majority of patients with INOCA with inducible CAS and/or an impaired adenosine-mediated vasodilation. In patients with INOCA without inducible CAS and normal adenosine-mediated vasodilation, two-thirds had endothelial dysfunction. These results indicate the relevance to perform endothelial function testing in patients with INOCA in view of its therapeutic implication.

中文翻译：

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缺血和非阻塞性冠状动脉患者存在冠状动脉内皮功能障碍、冠状动脉痉挛和腺苷介导的血管舒张性疾病

背景：缺血和非阻塞性冠状动脉 (INOCA) 患者的冠状动脉功能测试通常包括评估腺苷介导的血管舒张和乙酰胆碱痉挛激发。本研究的目的是评估额外的内皮功能检测对诊断 INOCA 患者血管舒缩功能障碍的诊断价值。方法：在这项回顾性队列研究中，我们纳入了接受临床指征的综合冠状动脉功能检测的 INOCA 患者。内皮功能障碍被定义为冠状动脉血流增加<50%，由多普勒血流和/或心外膜血管收缩与基线相比，以响应低剂量乙酰胆碱。冠状动脉痉挛（CAS）被定义为冠状动脉高剂量乙酰胆碱引起的血管痉挛性心绞痛或微血管性心绞痛。腺苷介导的血管舒张功能受损定义为冠状动脉血流储备 <2.5 和/或充血微血管阻力≥2.5。结果：在所有 110 名患者中，79% 患有内皮功能障碍，62% 患有 CAS，29% 患有腺苷-介导的血管舒张。80% 的 CAS 检测呈阳性和/或腺苷介导的血管舒张功能受损的患者存在内皮功能障碍。内皮功能测试将仅结合腺苷测试和痉挛激发的冠状动脉功能测试的诊断率提高了 17% 至 92%。在腺苷介导的血管舒张正常且无诱导性 CAS 的患者中，68% 的患者存在内皮功能障碍。结论：绝大多数 INOCA 患者伴有可诱发 CAS 和/或腺苷介导的血管舒张功能受损的内皮功能障碍。在没有诱导型 CAS 且腺苷介导的血管舒张正常的 INOCA 患者中，三分之二的患者出现内皮功能障碍。鉴于其治疗意义，这些结果表明在 INOCA 患者中进行内皮功能测试的相关性。