临床中，很多患者存在胸痛、胸闷等症状，然而冠脉造影却无明显异常，这类患者很可能患有冠状动脉微血管疾病（CMVD），其诊断与预后评估一直是个难题。近日，武汉协和医院兰晓莉、覃春霞、张晓教授团队发表在《Journal of Nuclear Medicine and Molecular Imaging》的研究给出新方案！
In clinical practice, many patients present with symptoms such as chest pain and chest tightness, yet coronary angiography shows no obvious abnormalities. These patients are likely suffering from coronary microvascular disease (CMVD), and its diagnosis and prognostic assessment have long been a challenge. Recently, a study led by The Team of Professors Lan Xiaoli, Qin Chunxia and Zhang Xiao from Wuhan Union Hospital, published in the 《Journal of Nuclear Medicine and Molecular Imaging》, has proposed a new solution!
研究通过对¹³N - 氨水 PET心肌灌注成像定量分析获得冠脉血流容量（CFC）图谱，整合静息/负荷心肌血流量（MBF）及冠脉血流储备（CFR）多参数，解决了传统 CFR 存在区域异质性、诊断不准确的痛点。
The study obtained coronary flow capacity (CFC) maps through quantitative analysis of ¹³N-ammonia PET myocardial perfusion imaging, integrating multiple parameters including resting/stress myocardial blood flow (MBF) and coronary flow reserve (CFR). This addresses the limitations of traditional CFR, such as regional heterogeneity and inaccurate diagnosis.
研究纳入83例CMVD患者，分为三类亚型：不伴阻塞性冠状动脉疾病和心肌病的CMVD（1型）、合并心肌病的CMVD（2型）、合并阻塞性冠状动脉疾病的CMVD（3型）。关键发现包括：① 2型患者MBF和CFR最低，CFC功能障碍区域最大；② 负荷MBF和严重CFC功能障碍区域面积可区分不同类型的CMVD；③ 严重CFC功能障碍区域和 CMVD 分型是治疗反应的预后因素，同时也是主要不良心血管事件（MACE）的独立预测因子。
A total of 83 CMVD patients were enrolled and classified into three subtypes: CMVD without obstructive coronary artery disease (CAD) and myocardial diseases; type 2, CMVD in the presence of myocardial diseases; type 3, CMVD co-existing with obstructive CAD. Key findings include: ① Type 2 patients had the lowest MBF and CFR, and the largest area of CFC dysfunction; ② MBF and the area of severeCFC dysfunction can distinguish different types of CMVD; ③ Severe CFC dysfunction area and CMVD classification were prognostic factors for therapy response, as well as independent predictors of MACE.
该研究首次证实CFC图不仅能精准分型CMVD，还能有效预测治疗效果和心血管事件风险，为临床制定个体化治疗方案提供了全新的无创评估工具，推动CMVD诊疗迈入精准化时代！
This study is the first to confirm that CFC mapping can not only accurately classify CMVD but also effectively predict treatment outcomes and cardiovascular event risks. It provides a novel non-invasive assessment tool for clinical development of individualized treatment plans, advancing CMVD diagnosis and treatment into the era of precision medicine!
根据严重CFC(A)和 CMVD类型(B)的Kaplan-Meier生存曲线
