Coronary Microvascular Dysfunction, Microvascular Angina, and Management.
Coronary Microvascular Dysfunction, Microvascular Angina, and Management.
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DOI：
10.1007/s11886-015-0682-9
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发表时间：
2016-01
影响因子：
3.7
通讯作者：
Bourque JM
中科院分区：
文献类型：
--
作者：
Löffler AI;Bourque JM
最近的分析发现，冠状动脉微血管功能障碍（CMD）预示着患有或不患有阻塞性心外膜冠状动脉疾病（CAD）的患者预后不良。无心外膜CAD时的胸痛是常见的。由CMD引起的心绞痛，即微血管心绞痛（MVA），通常与梗阻性心外膜CAD引起的心绞痛难以区分。最近出现的可以识别CMD的无创技术，如应激正电子发射断层扫描（PET）和心血管磁共振（CMR）心肌灌注成像，可以改进MVA的识别。使用这些工具，可以在历史上标记为心脏综合征x的异质人群中区分高风险的MVA患者和低风险的MVA患者。同样，在血管重建术成功后仍有持续性心绞痛的梗阻性心外膜CAD患者中也可以诊断出MVA。目前几乎没有证据支持MVA的治疗策略，目前的文献也没有明确定义CMD或治疗是否能改善预后。
Recent analyses have found that coronary microvascular dysfunction (CMD) portends a poor prognosis in patients with and without obstructive epicardial coronary artery disease (CAD). Chest pain in the absence of epicardial CAD is a common entity. Angina caused by CMD, microvascular angina (MVA), is often indistinguishable from that caused by obstructive epicardial CAD. The recent emergence of noninvasive techniques that can identify CMD, such as stress positron-emission tomography (PET) and cardiovascular magnetic resonance (CMR) myocardial perfusion imaging, allow improved identification of MVA. Using these tools, higher risk patients with MVA can be differentiated from those at lower risk in the heterogeneous population historically labeled as cardiac syndrome X. Likewise, MVA can be diagnosed in those with obstructive epicardial CAD who have persistent angina despite successful revascularization. There is little evidence to support current treatment strategies for MVA and current literature has not clearly defined CMD or whether therapy improves prognosis.