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논문 기본 정보

자료유형
학술저널
저자정보
저널정보
대한고혈압학회 Clinical Hypertension Clinical Hypertension 제25권 제2호
발행연도
2019.1
수록면
40 - 45 (6page)

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Abstract Background: Angina pectoris with a normal coronary angiogram, termed microvascular angina (MVA), is an important clinical entity; however, its causes remain unclear. Autonomic dysfunction is one of the possible causes. Therefore, this study aimed to investigate parasympathetic dysfunction assessed by heart rate recovery (HRR) and increased sympathetic activity assessed by exaggerated blood pressure (BP) response (EBPR) to exercise in MVA. Methods: The study participants were consecutive patients with anginal chest pain who underwent both coronary angiography with an ergonovine provocation test and a treadmill exercise test between January 2008 and February 2015. Patients with significant coronary artery disease (coronary artery stenosis ≥50%) or significant coronary artery spasm (≥90%) were excluded. Based on the treadmill exercise test, patients were categorized into the microvascular angina (MVA) group (patients with uniform ST depression ≥1 mm) and the control group. HRR was defined as peak heart rate minus heart rate after a 1 min recovery; blunted HRR was defined as ≤12 beats/min. EBPR was defined as a peak exercise systolic BP ≥210 mmHg in men and ≥ 190 mmHg in women. These parameters were compared between patients with MVA and the controls. Results: Among the 970 enrolled patients (mean age 53.1 years; female 59.0%), 191 (20.0%) were diagnosed with MVA. In baseline characteristics, the MVA group had older participants, female predominance, and a higher prevalence of hypertension. The MVA group showed significantly lower HRR 1 min (24.9 ± 15.9 vs. 31.3 ± 22.7, p < 0. 001) compared with the control group. Moreover, the proportion of EBPR was significantly higher in the MVA group than in the control group (21.5% vs. 11.6%, p < 0.001). Multivariable logistic regression analysis showed that age (odds ratio (OR), 1.045; 95% confidence interval (CI), 1.026–1.064; p < 0.001), HRR 1 min (OR, 0.990; 95% CI, 0. 982–0.999; p = 0.022), and EBPR (OR, 1.657; 95% CI, 1.074–2.554; p = 0.022) were independently associated with MVA. Conclusion: HRR and EBPR were associated with MVA, which suggests a link between MVA and autonomic dysregulation.

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참고문헌 (29)

참고문헌 신청
Kemp HG Jr / 1973 / Left ventricular function in patients with the anginal syndrome and normal coronary arteriograms / Am J Cardiol 32(3):375~376 google schola Lanza GA / 2014 / Management of microvascular angina pectoris / Am J Cardiovasc Drugs 14(1):31~40 google schola Kaski JC / 1995 / Cardiac syndrome X: clinical characteristics and left ventricular function. Long-term follow-up study / J Am Coll Cardiol 25(4):807~814 google schola Cannon RO 3rd / 1985 / Left ventricular dysfunction in patients with angina pectoris, normal epicardial coronary arteries, and abnormal vasodilator reserve / Circulation 71(2):218~226 google schola Jones E / 2012 / Cardiac syndrome X and microvascular coronary dysfunction / Trends Cardiovasc Med 22(6):161~168 google schola

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