Microvascular coronary dysfunction and ischemic heart disease: where are we in 2014?

Microvascular coronary dysfunction and ischemic heart disease: where are we in 2014?
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DOI:
10.1016/j.tcm.2014.09.013
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发表时间:
2015-02
影响因子:
9.3
通讯作者:
Pepine CJ
Pepine CJ
中科院分区:
医学2区
文献类型:
--
作者:
Petersen JW;Pepine CJ

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许多在负荷试验中有心绞痛和心肌缺血迹象的患者没有明显的梗阻性心外膜冠状动脉病变。在无梗阻性心外膜冠状动脉病变的情况下,有许多潜在的冠脉和非冠脉机制,其中突出的是冠脉微血管和/或内皮功能障碍。有冠状动脉微血管和/或内皮功能障碍的患者,尽管心室收缩功能得到保留,但发生不良心血管事件的风险往往增加,包括缺血事件和心力衰竭。在本文中,我们将回顾冠状动脉微血管和内皮功能障碍的诊断和治疗,讨论它们在射血分数保留的情况下对心力衰竭的潜在贡献,并重点介绍这些患者动脉粥样硬化形态评估的最新进展,这些患者中许多人都有非梗阻性心外膜疾病。
Many patients with angina and signs of myocardial ischemia on stress testing have no significant obstructive epicardial coronary disease. There are many potential coronary and non-coronary mechanisms for ischemia without obstructive epicardial coronary disease, and prominent among these is coronary microvascular and/or endothelial dysfunction. Patients with coronary microvascular and/or endothelial dysfunction are often at increased risk of adverse cardiovascular events, including ischemic events and heart failure despite preserved ventricular systolic function. In this article, we will review the diagnosis and treatment of coronary microvascular and endothelial dysfunction, discuss their potential contribution to heart failure with preserved ejection fraction, and highlight recent advances in the evaluation of atherosclerotic morphology in these patients, many of whom have non-obstructive epicardial disease.
DOI: 10.1056/nejm196705112761904
发表时间: 1967-01-01
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