焦虑与非阻塞性冠状动脉疾病患者心肌微循环：药物与精神压力CT灌注对比研究
结果显示MST后焦虑组MBF低于静息且MFR低于非焦虑组，焦虑严重程度与整体MFR及ΔGlobal-MBF负相关；PST后两组无显著差异。焦虑是MST后MBF降低的独立危险因素（OR=3.294）。
要点
- 对ANOCA合并焦虑患者，精神压力可诱发心肌微循环功能障碍，药物压力试验可能低估。
- MST后焦虑组MFR显著低于非焦虑组，焦虑越重MFR及ΔGlobal-MBF越低。
- 焦虑是MST后MBF降低的独立危险因素（OR=3.294，95%CI 1.009–10.754，P=0.046）。
核心结论
- 焦虑与ANOCA患者心肌微循环功能障碍相关，且是精神压力下MBF降低的独立危险因素。
- 精神压力试验较药物压力试验更能揭示焦虑相关的心肌微循环异常。
研究设计与样本
- 所有患者均行动态CT心肌灌注成像，分别接受MST（标准化颜色词/算术应激序列）和PST（regadenoson）。
- 按广泛性焦虑障碍量表分为焦虑组与非焦虑组。
- 采用17节段模型分析心肌血流量（MBF）和心肌血流储备（MFR）。
关键影像表现/征象
- MST后焦虑组MBF值低于静息状态（P<0.05），且焦虑组MFR低于非焦虑组（P<0.05）。
- 焦虑严重程度与整体MFR及ΔGlobal-MBF值呈负相关（r=-0.633，P<0.001；r=-0.667，P<0.001），与整体MBF下降值呈正相关（r=0.561，P=0.01）。
- PST后两组间MBF及MFR无显著差异，亦无显著相关性（P>0.05）。
诊断标准与关键数值
- 焦虑分组采用广泛性焦虑障碍量表。
- 心肌血流分析采用17节段模型，指标为MBF和MFR。
- 多因素logistic回归显示焦虑是MST后MBF降低的独立危险因素（OR=3.294，95%CI 1.009–10.754，P=0.046）。
临床应用与阅片要点
- 对ANOCA患者阅片时，若药物压力CT-MPI阴性但患者有焦虑，需考虑精神压力诱发微循环障碍的可能。
- 报告MFR时应结合患者焦虑状态解读，避免仅凭PST结果排除微循环病变。
局限性
- 原文未报告PST与MST的先后顺序或随机化方法，可能存在顺序效应。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
RATIONALE AND OBJECTIVES: Some patients with angina and non‑obstructive coronary artery disease (ANOCA) frequently present with anxiety. Mental stress can induce myocardial ischemia in patients with anxiety. This study aimed to assess myocardial microcirculation using dynamic CT myocardial perfusion imaging (CT-MPI) with mental stress test (MST) and pharmacologic stress test (PST) in ANOCA patients with anxiety.
MATERIALS AND METHODS: ANOCA patients underwent CT-MPI with MST using a series of the standardized color word/arithmetic stressors and PST using regadenoson, and divided into anxiety group and non-anxiety group according to the generalized anxiety disorder scale. Myocardial blood flow (MBF) and myocardial blood flow reserve (MFR) were analyzed, using a 17-segment model.
RESULTS: Sixty patients with 1020 segments were included for final analysis, including 29 patients with anxiety and 31 patients without anxiety. After MST, MBF value of the anxiety group was lower than that at rest (P < 0.05), and the anxiety group had a lower MFR compared to the non-anxiety group (P < 0.05); Anxiety severity was negatively correlated with global MFR and ΔGlobal-MBF value (r = -0.633, P < 0.001, r = -0.667, P < 0.001) and positively correlated with decreased global MBF value (r = 0.561, P = 0.01). In contrast, no significant differences or correlations were observed between the two groups after PST (P > 0.05). Multivariate logistic regression analysis revealed that anxiety is an independent risk factor for MBF reduction after MST in patients with ANOCA (OR=3.294, 95% CI: 1.009-10.754, P=0.046).
CONCLUSIONS: Anxiety is associated with myocardial microcirculation dysfunction (MMD) in patients with ANOCA. Anxiety is a risk factor for MMD under mental stress in ANOCA patients.
引用
- Yu X, Sun W, He J, et al. Assessing Myocardial Microcirculation in Patients with Anxiety and Non‑obstructive Coronary Artery Disease: A Comparative Study of Pharmacologic versus Mental Stress CT Myocardial Perfusion Imaging. Acad Radiol. 2026. PMID: 42142961. doi:10.1016/j.acra.2026.04.032
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。