Kardiologia polska · 2026
Anxiety, depression, sleep disorder, and coronary microvascular dysfunction in angina with non-obstructive coronary arteries.
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Sheng Zhaoxue, Li Xuexi, Chen Qiang, Che Wuqiang, Zhao Qi, Mu Yakun, Gao Yuanfeng, Gao Yanxiang, Zheng Jingang
Аннотация
BACKGROUND: Coronary microvascular dysfunction (CMD) is a key mechanism in angina with nonobstructivecoronary arteries (ANOCA). While psychological stress affects cardiovascular health,the link between specific psychological symptoms and CMD in ANOCA patients remains unclear.
AIMS: This study aimed to investigate the association of anxiety, depression, and sleep disorder with CMD assessed by invasive coronary physiology in ANOCA patients.
METHODS: A total of 102 ANOCA patients underwent coronary angiography and invasive coronary function testing including thermodilution-derived index of microcirculatory resistance (IMR) andcoronary flow reserve. CMD was defined as coronary flow reserve <2.5 or IMR ≥25. Anxiety, depression,and sleep quality were assessed using the Generalized Anxiety Disorder-7, Patient HealthQuestionnaire-9, Pittsburgh Sleep Quality Index scales, respectively.
RESULTS: Among the 102 enrolled ANOCA patients, 50.0% exhibited anxiety symptoms, 30.4%showed depression symptoms, and 67.6% reported sleep disorders. Patients with abnormal IMR hadsignificantly higher prevalence of anxiety (72.9% vs. 29.6%; P <0.001), depression (43.8% vs. 18.5%;P = 0.009), and sleep disorders (81.2% vs. 55.6%; P = 0.006) than those without. Multivariable analysisidentified anxiety as an independent predictor of CMD with abnormal IMR (odds ratio, 4.84; 95%confidence interval, 1.98-12.36; P <0.001). For CMD defined by abnormal coronary flow reserve, sleepdisorder showed a borderline association. Restricted cubic spline analyses showed that dose-dependentCMD risk increases with worsening psychological symptoms, especially for IMR-defined CMD.
CONCLUSIONS: Anxiety, depression, and sleep disorders are prevalent and dose-dependently associatedwith CMD in ANOCA, particularly elevated IMR.
AIMS: This study aimed to investigate the association of anxiety, depression, and sleep disorder with CMD assessed by invasive coronary physiology in ANOCA patients.
METHODS: A total of 102 ANOCA patients underwent coronary angiography and invasive coronary function testing including thermodilution-derived index of microcirculatory resistance (IMR) andcoronary flow reserve. CMD was defined as coronary flow reserve <2.5 or IMR ≥25. Anxiety, depression,and sleep quality were assessed using the Generalized Anxiety Disorder-7, Patient HealthQuestionnaire-9, Pittsburgh Sleep Quality Index scales, respectively.
RESULTS: Among the 102 enrolled ANOCA patients, 50.0% exhibited anxiety symptoms, 30.4%showed depression symptoms, and 67.6% reported sleep disorders. Patients with abnormal IMR hadsignificantly higher prevalence of anxiety (72.9% vs. 29.6%; P <0.001), depression (43.8% vs. 18.5%;P = 0.009), and sleep disorders (81.2% vs. 55.6%; P = 0.006) than those without. Multivariable analysisidentified anxiety as an independent predictor of CMD with abnormal IMR (odds ratio, 4.84; 95%confidence interval, 1.98-12.36; P <0.001). For CMD defined by abnormal coronary flow reserve, sleepdisorder showed a borderline association. Restricted cubic spline analyses showed that dose-dependentCMD risk increases with worsening psychological symptoms, especially for IMR-defined CMD.
CONCLUSIONS: Anxiety, depression, and sleep disorders are prevalent and dose-dependently associatedwith CMD in ANOCA, particularly elevated IMR.