Angina Pectoris and Myocardial Ischemia in the Absence of聽Obstructive Coronary聽Artery聽Disease: Practical Considerations for聽Diagnostic聽Tests

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• 作者：Francesco Radico ; MD ; Vincenzo Cicchitti ; MD ; Marco Zimarino ; MD ; PhD ; Raffaele De Caterina ; MD ; PhD ; ^{rdecater@unich.it" class="auth_mail}
• 关键词：angina ; myocardial ischemia ; normal coronary arteries ; cardiac syndrome X ; coronary spasm ; coronary microcirculation ; endothelial dysfunction
• 刊名：JACC: Cardiovascular Interventions
• 出版年：May 2014
• 年：2014
• 卷：7
• 期：5
• 页码：453-463
• 全文大小：917 K

文摘

Angina and myocardial ischemia without obstructive coronary artery disease are common clinical findings, often neglected for the assumption of a good prognosis. Most often, such patients are neither further investigated nor offered specific treatment beyond reassurance. However, the absence of significant coronary stenoses on angiography does not necessarily imply a “healthy” coronary tree. In such cases, myocardial ischemia may result from different types of functional disease involving the epicardial coronary arteries, the coronary microcirculation, or both; an accurate assessment of these components should be systematically performed after exclusion of organic epicardial disease because a correct diagnosis has relevant prognostic and therapeutic implications. Here we discuss the basic principles of diagnostic tests in this setting and propose a diagnostic sequence of reasonable practical implementation that may help identify patients at risk of future cardiac events.