【摘要】 目的 评估老年高血压合并缺血性卒中患者冠状动脉微血管功能障碍(CMD)发生情况及其与不良心脑血管事件(MACCE)风险的关系。方法 纵向队列研究。纳入2018年1月至2021年12月在张家口市第二医院住院的老年高血压合并缺血性卒中患者108例为卒中组,按照倾向性评分匹配法,依据1∶3选择基线资料匹配的未合并缺血性卒中的324例老年高血压患者为对照组。比较两组的基线临床资料。超声心动图计算冠状动脉血流速度储备(CFVR),将CFVR<2.5 cm/s定义为CMD。随访截至2023年2月,主要观察MACCE情况,包括全因死亡、非致死性急性冠状动脉综合征、心力衰竭入院和非致死性卒中。Pearson相关性分析评估CFVR与心功能的关系,Kaplanmeier生存分析评估两组的MACCE发生风险,Cox风险比例回归分析评估CFVR与发生MACCE的相关性。结果 432例老年高血压患者,女性207例(47.9%),年龄平均为(70.3±10.9)岁。两组的基线资料相似,具有可比性(均为P>0.05)。但卒中组患者的CMD更常见,表现为CFVR更低,CFVR<2.5 cm/s比例更高(均为P<0.05)。Pearson相关性分析结果显示,CFVR与舒张功能指标E/A显著负相关(r=-0.306),与左室整体纵向应变(r=-0.572)、圆周应变(r=-0.365)显著负相关,与整体径向应变显著正相关(r=0.313),与Log NT-proBNP显著负相关(r=-0.322)。随访2年,共有78例MACCE,卒中组和对照组分别有24例(22.2%)和54例(16.7%)。Kaplan-meier生存分析结果显示,卒中组的MACCE发生风险显著高于对照组(HR=1.331,95%CI:1.017～1.742,P=0.037)。多因素Cox风险比例回归分析结果显示,CMD与随访发生MACCE显著正相关(HR=1.214)。结论 本研究提示合并缺血性卒中的老年高血压患者同时发生CMD的风险明显增加,且增加了随访发生MACCE的风险。更多还原

【Abstract】 Objective To evaluate the incidence of coronary microvascular dysfunction(CMD) in elderly hypertensive patients with ischemic stroke and its relationship with the risk of major adverse cardiac and cerebrovascular event(MACCE). Methods This was a longitudinal cohort study. The 108 elderly hypertensive patients with ischemic stroke hospitalized in Second Hospital of Zhangjiakou from January 2018to December 2021 were included as the stroke group. According to the propensity score matching method,324 elderly hypertensive patients without ischemic stroke matched with baseline data were selected as the control group according to 1 ∶ 3. The baseline clinical data of the two groups were compared. Coronary flow velocity reserve(CFVR) was calculated by echocardiography, and CFVR<2. 5 cm/s was defined as CMD. Follow-up for 2 years after discharge, MACCE was mainly observed, including all-cause death, nonfatal acute coronary syndrome, admission to hospital with heart failure, and nonfatal stroke. Pearson correlation analysis was used to evaluate the relationship between CFVR and cardiac function, Kaplan-meier survival analysis was used to evaluate the risk of MACCE in the two groups, and Cox risk proportional regression analysis was used to evaluate the correlation between CFVR and MACCE. Results Of the 432 elderly hypertensive patients, 207(47. 9%) were female, with an average age of 70. 3±10. 9 years. The baseline data of the two groups were similar and comparable(all P>0. 05). However, CMD was more common in stroke patients, with lower CFVR and higher proportion of CFVR < 2. 5 cm/s( all P< 0. 05). Pearson correlation analysis showed that CFVR was negatively correlated with the index of diastolic function E/A(r=-0. 306), negatively correlated with overall longitudinal strain(r=-0. 572), circumferential strain(r=-0. 365), positively correlated with the overall radial strain(r= 0. 313), and negatively correlated with the index of wall stress Log NT-pro BNP(r=-0. 322). A total of 78 cases of MACCE were followed up for 2 years. There were 24 cases(22. 2%) in the stroke group and 54 cases(16. 7%) in the control group. Kaplan-meier survival analysis showed that the risk of MACCE in the stroke group was significantly higher than that in the control group(HR= 1. 331, 95%CI: 1. 017-1. 742, P= 0. 037). Multivariate Cox risk proportional regression analysis showed that CMD was significantly positively correlated with the occurrence of MACCE during follow-up(HR= 1. 214). Conclusions This study suggests that elderly hypertensive patients with ischemic stroke have a significantly increased risk of concurrent CMD, and increases the risk of MACCE during follow-up.更多还原