昆明医科大学学报2026，Vol.47Issue(2)：68-82,15.DOI:10.12259/j.issn.2095-610X.S20260208
caIMR、CMR对冠脉微循环障碍评估的对比分析及心脑微血管病变相关性研究
Comparative Analysis of caIMR and CMR in Assessing Coronary Microvascular Dysfunction and Correlation of Cardiac and Cerebral Microvascular Lesions
摘要
Abstract
Objective To evaluate the diagnostic efficacy of coronary angiography-based microcirculatory resistance index for coronary microcirculatory dysfunction through cardiac magnetic resonance(CMR),and further explore the correlation between coronary microcirculatory dysfunction and silent cerebral infarction.Methods 231 patients from the Cardiovasology Department of the Second Affiliated Hospital of Kunming Medical University between January 2021 and December 2024 were selected.The caIMR value of the left anterior descending coronary artery was analyzed using the FlashAngio system,with patients divided into normal coronary microcirculation group(caIMR<25,n=126)and coronary microcirculatory dysfunction group(caIMR≥25,n=105).General clinical data,laboratory indicators(complete blood count,biochemical panel,glycated hemoglobin),cranial CT/MRI results,cardiac microcirculatory perfusion MRI parameters(time to peak[tpeak],relative signal intensity at peak[RSIpeak],maximum upslope[Slopemax]),and routine transthoracic echocardiography parameters of all patients were collected.Results(1)Among 50 patients who completed both CMR and caIMR,the caIMR≥25 group showed varying degrees of tpeak prolongation,with reduced RSIpeak and Slopemax,indicating coronary microcirculatory dysfunction.Cohen's Kappa consistency analysis showed a Kappa value of 0.839(P<0.05),suggesting high accuracy of caIMR in identifying CMD;(2)127 diabetic patients were categorized based on HbA1c levels into good glycemic control group(4%≤HbA1c<6%),moderate glycemic control group(6%≤HbA1c<8%),and poor glycemic control group(HbA1c≥8%).Comparing 40 patients in the good control group,59 in the moderate control group,and 28 in the poor control group,the median caIMR values in the moderate and poor control groups were higher than the good control group(P<0.05).The moderate control group's median caIMR of 24.60 was close to the diagnostic threshold of 25,while the poor control group's median caIMR of 32.15 was significantly higher;(3)In the coronary microcirculatory dysfunction group,several patients simultaneously had silent cerebral infarction,which was less common in the normal microcirculation group,with statistically significant difference(P<0.05).Further Phi coefficient correlation analysis showed a coefficient of 0.562,with statistically significant difference(P<0.001),suggesting a correlation between coronary microcirculatory dysfunction and silent cerebral infarction.Conclusion caIMR demonstrates high accuracy in identifying coronary microcirculatory dysfunction,with good consistency with CMR assessment.The high prevalence of silent cerebral infarction in patients with coronary microcirculatory dysfunction suggests potential interconnected pathological development in cerebral and cardiac microvascular systems.关键词
caIMR/心脏磁共振/冠状动脉微循环障碍/无症状脑梗死Key words
CaIMR/Coronary microvascular disease/Cardiac magnetic resonance/Silent brain infarction分类
医药卫生引用本文复制引用
虞敏,孙林..caIMR、CMR对冠脉微循环障碍评估的对比分析及心脑微血管病变相关性研究[J].昆明医科大学学报,2026,47(2):68-82,15.基金项目
云南省"心脑同治"临床医学关键新技术研发项目(202203AC100007) （202203AC100007）
