| Objective:Coronary microvascular dysfunction（CMD）might be associated with fat accumulation and fat distribution.This study sought to investigate the effects of different types of obesity patterns on coronary microvascular function in male and female patients with non-obstructive coronary artery disease.Methods:We retrospectively analyzed 254 patients with clinically suspected CMD,who underwent the one-day rest and stress 13N-NH3 positron emission tomography myocardial perfusion imaging in First Hospital of Shanxi Medical University between December 2015and January 2021.Besides,all patients were confirmed to have non-obstructive coronary artery disease by imaging examinations.Normal weight was defined as a body mass index（BMI）=18.5-24.0 kg/m2,overweight as a BMI=24.0-27.9 kg/m2 and overall obesity as BMI≥28kg/m2.Central obesity（CO）was defined as a waist circumference≥90 cm for male and a waist circumference≥85 cm for female.Hyperemic myocardial blood flow（MBF）<2.3 m L/min/g or coronary flow reserve（CFR）<2.5 were considered indicative of CMD.Male and female patients were grouped separately based on their BMI and waist circumference into 5 anthropometric groups:normal weight with non-central obesity（NWNCO）,normal weight with central obesity（NWCO）,overweight with non-central obesity（OWNCO）,overweight with central obesity（OWCO）and obesity with central obesity（OBCO）.MBF,CFR,coronary microvascular resistance（CMVR）and the incidence of CMD were compared among different genders and different types of obesity patterns from the same gender.In addition,a Logisitc regression was performed to identify the variables associated with CMD by gender.Results:⑴A total of 254 patients were included in our study,consisting of 152 male and 102female patients.Compared with the male patients,female patients had the higher resting and hyperemic MBF,and the lower CMVR（both P<0.05）.CFR did not differ between groups（P=0.12）.In our study,the incidence of CMD in males was significantly higher than in females（48%VS.16.9%,P<0.01）.⑵The male patients consisted of 30 in the NWNCO group,15 in the NWCO group,20 in the OWNCO group,41 in the OWCO group and 46 in the OBCO group.Resting MBF did not differ between groups（F=1.14,P=0.34）.Compared with the NWNCO group,NWCO,OWCO and OBCO groups had the lower hyperemic MBF and CFR,the higher CMVR and the higher the incidence of CMD.There were no significant differences in hyperemic MBF,CFR,CMVR and the incidence of CMD between the NWNCO and OWNCO groups（both P>0.05）.Similarly,there were no significant differences in hyperemic MBF,CFR,CMVR and the incidence of CMD between the NWCO,OWCO and OBCO groups（both P>0.05）.Notably,patients with NWCO presented the lowest hyperemic MBF and CFR,the highest CMVR and the highest incidence of CMD.For male patients,age（OR=1.066,95%CI:1.02-1.114,P=0.005）and waist circumference（OR=1.054,95%CI:1.009-1.101,P=0.018）were independent risk factors for CMD.⑶The female patients consisted of 36 in the NWNCO group,8 in the NWCO group,12 in the OWNCO group,30 in the OWCO group and 16 in the OBCO group.Resting MBF did not differ between groups（F=1.82,P=0.13）.Compared with the NWNCO group,the NWCO,OWCO and OBCO groups had the lower hyperemic MBF and CFR,and the higher CMVR（both P<0.05）.There were no significant differences in hyperemic MBF,CFR,and CMVR between the NWNCO and OWNCO groups（both P>0.05）.Similarly,there were no significant differences in hyperemic MBF,CFR,and CMVR between the NWCO,OWCO and OBCO groups（both P>0.05）.The incidence of CMD was higher in patients with CO,but no statistical significance（P=0.25）.For female patients,BMI（OR=1.347,95%CI:1.001-1.813,P=0.049）was an independent risk factor for CMD and heart rate reserve（OR=0.015,95%CI:0-0.588,P=0.025）was an independent protective factor for CMD.Conclusions:In patients with non-obstructive CAD,CO may be associated with an increased risk of CMD.Male patients with normal BMI and CO had the highest risk of CMD.Objective: Central obesity（CO）was a leading risk factor for obstructive sleep apnea（OSA）,and they were both closely related to the occurrence and development of coronary heart disease.This study sought to investigate the effects of CO,OSA and OSA with CO on coronary microvascular function in male patients with non-obstructive coronary artery disease.Methods: From December 2017 to December 2021,105 consecutive male patients with nonobstructive coronary artery disease by angiography were enrolled in the study.All patients underwent the one-day rest and stress 13N-NH3 PET MPI within one month of the end of angiography.CO was defined as a waist circumference≥90 cm for male.The diagnosis of OSA was established by a standard overnight polysomnographic.Hyperemic MBF<2.3 m L/min/g or CFR<2.5 were considered indicative of CMD.According to waist circumference and polysomnographic findings,patients were classified into 3 groups: control group（non-CO with non-OSA）,CO group（CO with non-OSA）,OSA with CO group（OSA with CO）.MBF,CFR,CMVR and the incidence of CMD were compared among groups.Results: Resting MBF did not differ between groups（F=0.11,P=0.9）.Hyperemic MBF and CFR showed a decreasing trend among the three groups.The lowest hyperemic MBF and CFR were observed in the OSA with CO group and these differences turned out to be statistically significant when compared to the controls（both P<0.05）.CMVR showed show a raising trend among the three groups and CMVR was significantly higher in the CO and OSA with CO groups compared to the control group（both P<0.05）.Univariate linear regression analysis demonstrated that CO was a risk factor for reduced hyperemic MBF（β=-0.423,P=0.006）and reduced CFR（β=-0.438,P=0.019）,as well as elevated CMVR（β=9.426,P<0.01）.OSA may also lead to a reduction in hyperemic MBF and CFR,as well as an elevation of CMVR,but were not statistically significant（both P>0.05）.Multivariate Logisitc regression analyses demonstrated that CO was independently associated with increased risk of CMD,and OSA with CO increased the risk further.Conclusions: CO and OSA may both lead to decreased coronary microvascular function in male patients.OSA with CO could lead to additional decrease in coronary microvascular function and increase in risk of CMD.Taking into CO and OSA may help to risk stratify of male patients with non-obstructive coronary artery disease.Objective: CMD was a leading cause of myocardial ischemia in patients with non-obstructive coronary artery disease and closely related to the poor prognosis.As a non-invasive method for the treatment of ischemic heart disease,enhanced external counter pulsation（EECP）may be effective in the treatment of CMD.The aim of our study was to investigate the effects of EECP on coronary microvascular function and endothelial function in patients with non-obstructive coronary artery disease.Methods: Twenty-four patients with documented non-obstructive coronary artery disease by angiography underwent EECP therapy for 36 one-hour sessions.They underwent the quantitative 13N-NH3 PET MPI for the assessment of MBF,CFR and CMVR,before and after EECP therapy.In addition,doppler ultrasound was used to assess brachial artery flowmediated dilatation（FMD）before and after treatment.Results: There was no significant alteration in resting MBF before and after treatment（0.9±0.19 m L/min to 0.87±0.19 m L/min/g,P=0.29）.Hyperemic MBF stimulated by adenosine improved significantly after therapy（2.53±0.73 m L/min/g to 2.88±0.92 m L/min/g,P< 0.01）.As the ratio of stress to rest MBF,CFR was significantly increased compared with the level before treatment（2.85±0.76 to 3.33±0.81,P<0.01）.Compared with before treatment,CMVR was significantly reduced after treatment（37.17±15.83 mm Hg m L-1min-1g-1 to 31.28±11.43 mm Hg m L-1min-1g-1,P<0.01）.Besides,FMD also improved significantly after therapy（4.39±1.38% to 4.94±1.01%,P=0.04）.Conclusion: EECP may have an effect in improving coronary microvascular function in patients with non-obstructive coronary artery disease.Such improvement may be related to the favorable effects of EECP on endothelial function to some extent. |
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