冷加压试验联合多模态影像诊断血管痉挛性心绞痛1例

Cold Pressor Test Combined with Multimodal Imaging in the Diagnosis of Vasospastic Angina: A Case Report

摘要: 目的：探讨核素心肌灌注显像、冠状动脉造影、超声斑点追踪联合冷加压试验在血管痉挛性心绞痛中的诊断价值及机制。方法：报告1例40岁发作性夜间胸闷患者，采用多模态影像学联合冷加压试验进行评估。结果：患者冠状动脉无显著阻塞性病变，静息核素心肌灌注显像提示中度张力性缺血，硝酸甘油介入后可完全恢复；运动及冷加压负荷显像呈反向再分布；冠状动脉造影示慢血流，冷加压后慢血流加重且无大血管痉挛；超声斑点追踪示冷加压后局部心肌应变显著减低。结论：多模态影像联合冷加压试验有助于识别缺血伴非阻塞性冠状动脉疾病中的微血管痉挛，为血管痉挛性心绞痛的诊断、分型及治疗提供客观、全面的影像学与功能学依据，是一种有前景的诊断策略。本研究为单中心个案报告，样本量有限，结论尚需大样本临床研究进一步验证。

Abstract: Objective: To investigate the diagnostic value and mechanism of myocardial perfusion imaging, coronary angiography, ultrasound speckle tracking combined with cold pressor test in vasospastic angina. Methods: A 40-year-old patient with paroxysmal nocturnal chest distress was reported and evaluated by multimodal imaging combined with cold pressor test. Results: No significant obstructive coronary artery disease was found. Rest myocardial perfusion imaging showed moderate tension ischemia, which was completely recovered after nitroglycerin intervention. Reverse redistribution was presented on exercise and cold pressor stress imaging. Coronary slow flow was observed on angiography, which was aggravated after cold pressor test without epicardial spasm. Ultrasound speckle tracking showed significantly decreased regional myocardial strain after cold pressor test. Conclusion: Multimodal imaging combined with the cold pressor test helps identify microvascular spasm in patients with ischemia and non-obstructive coronary artery disease, providing objective and comprehensive imaging and functional evidence for the diagnosis, classification, and treatment of vasospastic angina. It represents a promising diagnostic strategy. This study is a single-center case report with a limited sample size; thus, the conclusions require further validation in large-scale clinical studies.