Coronary microvascular dysfunction, microvascular angina, and treatment strategies.
Coronary microvascular dysfunction, microvascular angina, and treatment strategies.
复制标题
DOI：
10.1016/j.jcmg.2014.12.008
复制
发表时间：
2015-02
影响因子：
14
通讯作者：
Bourque, Jamieson M.
中科院分区：
文献类型：
--
作者：
Marinescu, Mark A.;Loffler, Adrian I.;Ouellette, Michelle;Smith, Lavone;Kramer, Christopher M.;Bourque, Jamieson M.
无冠状动脉疾病（CAD）的心绞痛具有相当高的发病率，并且存在于10-30%接受血管造影术的患者中。这些患者中有50-65%存在冠状动脉微血管功能障碍（CMD）。该队列的最佳治疗尚未确定。我们进行了一项系统回顾，以评估在没有CAD的情况下客观定义的CMD的治疗策略。我们纳入了在无冠状动脉狭窄≥50%或结构性心脏病的情况下，通过正电子发射断层扫描（PET）、心脏磁共振成像（CMR）、稀释方法或冠状动脉内多普勒评估心绞痛和冠状动脉血流储备（CFR）或心肌灌注储备（MPR）<2.5的人类受试者治疗的研究。只有8篇文章符合严格的纳入标准。这些文章是异质性的，使用不同的治疗方法、终点和CMD定义。小样本量严重限制了这些研究的功效，每次分析平均11名患者。评价西地那非、喹那普利、雌激素和经皮神经电刺激（TENS）应用的研究证明了其各自终点的获益。未发现L-精氨酸、多沙唑嗪、普伐他汀和地尔硫卓的获益。我们的系统综述强调，几乎没有数据支持CMD的治疗。我们评估符合严格纳入标准的数据，并回顾相关但排除的文献。我们还描述了解决这一研究空白所需的下一步措施，包括CMD的标准化定义，在无阻塞性CAD的胸痛研究中对CMD的常规评估，以及在确诊CMD人群中的特定治疗评估。
Angina without coronary artery disease (CAD) has substantial morbidity and is present in 10–30% of patients undergoing angiography. Coronary microvascular dysfunction (CMD) is present in 50–65% of these patients. The optimal treatment of this cohort is undefined. We performed a systematic review to evaluate treatment strategies for objectively defined CMD in the absence of CAD. We included studies assessing therapy in human subjects with angina and coronary flow reserve (CFR) or myocardial perfusion reserve (MPR) <2.5 by positron emission tomography (PET), cardiac magnetic resonance imaging (CMR), dilution methods, or intracoronary Doppler in the absence of coronary artery stenosis ≥50% or structural heart disease. Only 8 articles met strict inclusion criteria. The articles were heterogeneous, using different treatments, end-points, and definitions of CMD. Small sample sizes severely limit the power of these studies, with an average of 11 patients per analysis. Studies evaluating, sildenafil, quinapril, estrogen, and transcutaneous electrical nerve stimulation (TENS) application demonstrated benefits in their respective endpoints. No benefit was found with L-arginine, doxazosin, pravastatin, and diltiazem. Our systematic review highlights that there is little data to support therapies for CMD. We assess the data meeting rigorous inclusion criteria and review the related but excluded literature. We additionally describe the next steps needed to address this research gap, including a standardized definition of CMD, routine assessment of CMD in studies of chest pain without obstructive CAD, and specific therapy assessment in the population with confirmed CMD.