INTRODUCTION To study the prognostic factors of patients with chest pain and without obstructive coronary artery disease is of great significance for the management of such patients. We assessed whether a high-sensitivity troponin I (hs-TnI) is associated with prognosis in patients with chest pain and without obstructive coronary artery disease. METHODS From 2011 to 2017, 489 consecutively hospitalized patients with chest pain and without significant coronary artery stenosis (<50%) were tested for hs-TnI and underwent stress myocardial contrast echocardiography. Myocardial blood flow reserve (MBFR) was measured by stress myocardial contrast echocardiography. Patients were followed (median, 41months) for composite endpoints, including cardiovascular death and nonfatal myocardial infarction. Cox proportional hazards models were performed to determine associations between hs-TnI and the composite endpoints. RESULTS Among 489 patients with chest pain and without significant coronary artery stenosis, 257 patients (52.6%) had elevated hs-TnI. Compared to patients with normal hs-TnI, patients with elevated hs-TnI were older (P = 0.013) and had a higher prevalence of atrial fibrillation (P = 0.003), higher left ventricular mass index (P = 0.002) and E/e' septal (P < 0.001), and a lower MBFR (P< 0.001). After adjustment, there was still a significant association between hs-TnI and MBFR (odds ratio = 1.145; 95% CI: 1.079--1.214, P< 0.001). Compared with patients with normal hs-TnI, patients with elevated hs-TnI had a greater cumulative event rate (log-rank P = 0.002). Males (hazard ratio 4.770; 95% CI, 1.175--19.363; P=0.029) and reduced MBFR (hazard ratio 2.496; 95% CI, 1.446--4.311; P=0.001) were risk factors associated with composite endpoints in patients with elevated hs-TnI. CONCLUSIONS In patients with chest pain and without obstructive coronary artery disease, elevated hs-TnI is associated with decreased myocardial perfusion by contrast echocardiography as well as a higher incidence of cardiovascular events.

中文翻译：

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无阻塞性冠状动脉疾病患者肌钙蛋白升高与心肌血流储备减少之间的关联。

引言 研究无阻塞性冠状动脉疾病的胸痛患者的预后因素对于此类患者的治疗具有重要意义。我们评估了高敏肌钙蛋白 I (hs-TnI) 是否与胸痛且无阻塞性冠状动脉疾病患者的预后相关。方法 2011年至2017年连续住院治疗的489例无明显冠状动脉狭窄（<50%）的胸痛患者进行hs-TnI检测并进行负荷心肌造影超声心动图检查。通过负荷心肌造影超声心动图测量心肌血流储备（MBFR）。对患者进行复合终点随访（中位时间 41 个月），包括心血管死亡和非致命性心肌梗死。进行 Cox 比例风险模型以确定 hs-TnI 与复合终点之间的关联。结果 489 例胸痛且无明显冠状动脉狭窄的患者中，257 例（52.6%）患者 hs-TnI 升高。与 hs-TnI 正常的患者相比，hs-TnI 升高的患者年龄较大（P = 0.013），房颤患病率较高（P = 0.003），左心室质量指数较高（P = 0.002）和 E/e ' 间隔（P < 0.001），并且 MBFR 较低（P < 0.001）。调整后，hs-TnI 与 MBFR 之间仍存在显着相关性（比值比 = 1.145；95% CI：1.079--1.214，P < 0.001）。与 hs-TnI 正常的患者相比，hs-TnI 升高的患者的累积事件发生率更高（对数秩 P = 0.002）。男性（风险比 4.770；95% CI，1.175--19.363；P=0.029）和 MBFR 降低（风险比 2.496；95% CI，1.446--4.311；P=0.001）是与以下患者复合终点相关的危险因素： hs-TnI 升高。结论 在胸痛且无阻塞性冠状动脉疾病的患者中，超声心动图显示 hs-TnI 升高与心肌灌注减少以及心血管事件发生率较高相关。