| Background and ObjectiveAccording to the statistical report released by the health commission in 2019,coronary heart disease is the first cause of death in China after malignant tumors.Coronary heart disease was previously defined as obstructive coronary atherosclerosis involving epicardial coronary artery.However,more and more patients with heart disease with chest pain,chest tightness or dyspnea as the main complaint have no obvious obstructive lesions in epicardial coronary artery through coronary angiography,but there is evidence of myocardial ischemia in action ECG or exercise test.This situation is called ischemia and no obstructive coronary artery disease(INOCA).Studies have shown that INOCA patients have an increased risk of myocardial infarction or other adverse cardiovascular events(MACE).Related studies showed that the incidence rate of INOCA was high.About 40%of male patients had no obvious stenosis of epicardium in coronary angiography,and the proportion of female patients was higher than 50%.INOCA may be the result of multiple factors.Smoking,obesity,diabetes,inflammation and so on are all related risk factors.The mechanism is related to coronary vasospasm or microvascular dysfunction(CMD).At present,coronary microvascular dysfunction(CMD)is mainly evaluated by coronary flow reserve(CFR).CMD can be diagnosed if there is no obvious stenosis of epicardial vessels and the evaluated CFR is less than 2-2.5.Studies have shown that low CFR is associated with poor prognosis in patients with coronary artery disease.In recent years," Psycho-cardiology" has attracted much attention.The probability of patients with coronary heart disease suffering from psychological related diseases has increased significantly.Foreign studies have shown that the prevalence of depression in patients with coronary heart disease is 12%.They affect each other and aggravate the poor prognosis.Some studies have shown that anxiety and depression can reduce vagus nerve activity,flow mediated endothelial relaxation(FMD)and endothelial repair ability.However,there is no study on the relationship between anxiety and depression and coronary microvascular function in patients with INOCA.By comparing the differences of anxiety and depression between the microvascular dysfunction group and the control group,this study clarified the effect of anxiety and depression on coronary flow reserve(CFR)in patients with ischemia and non obstructive coronary artery disease(INOCA),found the adverse prognostic factors of INOCA,and provided a new diagnosis and treatment scheme for this group of patients.Methods198 consecutive patients were selected.From June 2020 to June 2021,they were hospitalized in our hospital due to chest pain and chest tightness.The dynamic electrocardiogram or exercise load test was positive,but the coronary angiography showed no obvious stenosis of large vessels(stenosis<50%).We collected history of hypertension,diabetes,medication history,inflammatory markers,heart rate variability,creatinine clearance and other indicators.According to the results of CFR,they were divided into two groups.CFR<2 was the coronary microvascular disease(CMD)gr oup,and CFR≥ 2 was the control group.All the selected patients were measured with hospital anxiety and Depression Scale(HADS),and the differences of anxiety and depression between the two groups were compared.SPSS 22.0 software was used for statistical analysis of all data.Chi square test was used to compare whether there were differences in anxiety and depression between the two groups.Multivariate logistic regression was used to analyze the risk factors of low CFR,If P<0.05,the difference is considered statistically significant.Results1.Compared to the control group,there were significant differences in age,body mass index,proportion of smokers,history of diabetes,history of hypertension,use of Calcium channel blocker,ESR,procalcitonin(PCT),C-reactive protein(CRP),mean heart rate,SDNN,MSD,and the proportion of anxiety and depression in CMD group,the difference was statistically significant(p<0.05).2.Pearson correlation analysis showed that anxiety and depression were associated with microvascular dysfunction(χ2=4.232,P=0.040,r=0.146).3.From multivariate logistic regression analysis,the independent risk factors of low CFR were anxiety and depression(OR=3.440,95%CI:1.421-8.326,P=0.006),smoking(OR=6.905,95%CI:1.906-25.017,P=0.003),diabetes(OR=8.496,95%CI:2.008-35.954,P=0.004),BMI(OR=1.202,95%CI:1.0531.373,P=0.007),ESR(OR=1.134,95%CI:1.034-1.244,P=0.007),MSD(root mean square of the normal adjacent sinus R-R interval difference)(OR=1.014,95%CI:1.034-1.244,P=0.007)and reduced mean heart rate(OR=0.950,95%CI:0.912-0.990,P=0.015).Conclusion1.Anxiety and depression were associated with low CFR.2.Anxiety and depression were independent risk factors for low CFR.3.In addition,smoking,diabetes,hypertension and MSD were also independent risk factors for low CFR.Smoking、diabetes、BMI、ESR、MSD、reduced mean heart ratewere the independent risk factors of low CFR. |
