冠状动脉微血管疾病诊治新进展
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摘要
既往认为心外膜冠状动脉阻塞性疾病是心绞痛的主要病因,但部分缺血性胸痛患者的心外膜冠脉造影结果正常或者接近正常,说明冠状动脉微血管病变在其中发挥了重要作用。近20年来的研究为冠脉微循环病变在缺血性心脏病发病中的作用积累了众多证据。本文对冠状动脉微血管疾病的发病机制、诊断和治疗进行评述,以增进临床医生对该病的认识。
Obstructive disease of epicardial coronary arteries has been recognized as the dominating pathogenesis of angina pectoris.However,epicardial coronary angiography in some patients with ischemic chest pain shows normal or close to normal,which indicates that coronary microangiopathy might play an important role.Over the past 20 years,serious researches have accumulated evidences to verify the role of coronary microcirculation in the pathogenesis of ischemic heart disease.In order to enhance clinicians′ recognition,this article will systemically review the pathogenesis,diagnosis and treatment of coronary microvascular disease.
Obstructive disease of epicardial coronary arteries has been recognized as the dominating pathogenesis of angina pectoris.However,epicardial coronary angiography in some patients with ischemic chest pain shows normal or close to normal,which indicates that coronary microangiopathy might play an important role.Over the past 20 years,serious researches have accumulated evidences to verify the role of coronary microcirculation in the pathogenesis of ischemic heart disease.In order to enhance clinicians′ recognition,this article will systemically review the pathogenesis,diagnosis and treatment of coronary microvascular disease.
引文
[1]Casadonte L,Verhoeff Bart-Jan,Piek JJ,et al.Influence of increased heart rate and aortic pressure on resting indices of functional coronary stenosis severity[J].Basic Res Cardiol,2017,112(6):61.
[2]Herrmann J,Kaski JC,Lerman A.Coronary microvascular dysfunction in the clinical setting:from mystery to reality[J].Eur Heart J,2012,33(22):2771-2782b.
[3]Crea F,Camici PG,Bairey MCN.Coronary microvascular dysfunction:an update[J].Eur Heart J,2014,35(17):1101-1111.
[4]Tondi P,Santoliquido A,Di AG,et al.Endothelial dysfunction as assessed by flow-mediated dilation in patients w ith cardiac syndrome X:role of inflammation[J].Eur Rev M ed Pharmacol Sci,2011,15(9):1074-1077.
[5]Recio-Mayoral A,Rimoldi OE,Camici PG,et al.Inflammation and microvascular dysfunction in cardiac syndrome X patients w ithout conventional risk factors for coronary artery disease[J].JACC Cardiovasc Imaging,2013,6(6):660-667.
[6]Sestito A,Lanza GA,Di Monaco A,et al.Relation between cardiovascular risk factors and coronary microvascular dysfunction in cardiac syndrome X[J].J Cardiovasc M ed(Hagerstow n),2011,12(5):322-327.
[7]2013 ESC guidelines on the management of stable coronary artery disease.The Task Force on the management of stable coronary artery disease of the European Society of Cardiology[J].Eur Heart J,2013,34(38):2949-3003.
[8]中华医学会心血管病学分会基础研究学组,中华医学会心血管病学分会介入心脏病学组.冠状动脉微血管疾病诊断和治疗的中国专家共识[J].中国循环杂志,2017,32(5):421-430.
[9]Lanza GA,Crea F.Primary coronary microvascular dysfunction:clinical presentation,pathophysiology,and management[J].Circulation,2010,121(21):2317-2325.
[10]Murthy VL,Naya M,Taqueti VR,et al.Effects of sex on coronary microvascular dysfunction and cardiac outcomes[J].Circulation,2014,129(24):2518-2527.
[11]Shufelt CL,Thomson LEJ,Goykhman P,et al.Cardiac magnetic resonance imaging myocardial perfusion reserve index assessment in w omen w ith microvascular coronary dysfunction and reference controls[J].Cardiovasc Diagn Ther,2013,3(3):153-160.
[12]Xiaozhen H,Yun Z,Mei Z,et al.Effect of carvedilol on coronary flow reserve in patients w ith hypertensive left-ventricular hypertrophy[J].Blood Press,2010,19(1):40-47.
[13]Tagliamonte E,Rigo F,Cirillo T,et al.Effects of ranolazine on noninvasive coronary flow reserve in patients w ith myocardial ischemia but w ithout obstructive coronary artery disease[J].Echocardiography,2015,32(3):516-521.
[14]马宗仑,徐萌萌,谭丽娟,等.Rho激酶抑制剂法舒地尔对微血管心绞痛患者的疗效观察[J].岭南心血管病杂志,2015,21(5):597-600.
[15]Gurbel PA,Bliden KP,Butler K,et al.Randomized doubleblind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients w ith stable coronary artery disease:the ONSET/OFFSET study[J].Circulation,2009,120(25):2577-2585.
[16]Park SD,Lee MJ,Baek YS,et al.Randomised trial to compare a protective effect of clopidogrel versus ticagrelor on coronary microvascular injury in ST-segment elevation myocardial infarction(CV-TIM E trial)[J].Eurointervention I,2016,12(8):e964-e971.
[17]Beltrame JF,Turner SP,Leslie SL,et al.The angiographic and clinical benefits of mibefradil in the coronary slow flow phenomenon[J].J Am Coll Cardiol,2004,44(1):57-62.
[18]吴农田,李水花,樊明振.前列地尔对急性冠脉综合征PCI术后心肌灌注及心功能的影响[J].海南医学,2018,29(6):757-759.
[19]Ito N,Nanto S,Doi Y,et al.High index of microcirculatory resistance level after successful primary percutaneous coronary intervention can be improved by intracoronary administration of nicorandil[J].Circ J,2010,74(5):909-915.
[20]Garg R,Rao AD,Baimas-George M,et al.Mineralocorticoid receptor blockade improves coronary microvascular function in individuals w ith type 2 diabetes[J].Diabetes,2015,64(1):236-242.
[21]Hai-tao Z,Zhen-hua J,Jian Z,et al.No-reflow protection and long-term efficacy for acute myocardial infarction w ith Tongxinluo:a randomized double-blind placebo-controlled multicenter clinical trial(ENLEAT Trial)[J].Chin M ed J,2010,123(20):2858-2864.
[2]Herrmann J,Kaski JC,Lerman A.Coronary microvascular dysfunction in the clinical setting:from mystery to reality[J].Eur Heart J,2012,33(22):2771-2782b.
[3]Crea F,Camici PG,Bairey MCN.Coronary microvascular dysfunction:an update[J].Eur Heart J,2014,35(17):1101-1111.
[4]Tondi P,Santoliquido A,Di AG,et al.Endothelial dysfunction as assessed by flow-mediated dilation in patients w ith cardiac syndrome X:role of inflammation[J].Eur Rev M ed Pharmacol Sci,2011,15(9):1074-1077.
[5]Recio-Mayoral A,Rimoldi OE,Camici PG,et al.Inflammation and microvascular dysfunction in cardiac syndrome X patients w ithout conventional risk factors for coronary artery disease[J].JACC Cardiovasc Imaging,2013,6(6):660-667.
[6]Sestito A,Lanza GA,Di Monaco A,et al.Relation between cardiovascular risk factors and coronary microvascular dysfunction in cardiac syndrome X[J].J Cardiovasc M ed(Hagerstow n),2011,12(5):322-327.
[7]2013 ESC guidelines on the management of stable coronary artery disease.The Task Force on the management of stable coronary artery disease of the European Society of Cardiology[J].Eur Heart J,2013,34(38):2949-3003.
[8]中华医学会心血管病学分会基础研究学组,中华医学会心血管病学分会介入心脏病学组.冠状动脉微血管疾病诊断和治疗的中国专家共识[J].中国循环杂志,2017,32(5):421-430.
[9]Lanza GA,Crea F.Primary coronary microvascular dysfunction:clinical presentation,pathophysiology,and management[J].Circulation,2010,121(21):2317-2325.
[10]Murthy VL,Naya M,Taqueti VR,et al.Effects of sex on coronary microvascular dysfunction and cardiac outcomes[J].Circulation,2014,129(24):2518-2527.
[11]Shufelt CL,Thomson LEJ,Goykhman P,et al.Cardiac magnetic resonance imaging myocardial perfusion reserve index assessment in w omen w ith microvascular coronary dysfunction and reference controls[J].Cardiovasc Diagn Ther,2013,3(3):153-160.
[12]Xiaozhen H,Yun Z,Mei Z,et al.Effect of carvedilol on coronary flow reserve in patients w ith hypertensive left-ventricular hypertrophy[J].Blood Press,2010,19(1):40-47.
[13]Tagliamonte E,Rigo F,Cirillo T,et al.Effects of ranolazine on noninvasive coronary flow reserve in patients w ith myocardial ischemia but w ithout obstructive coronary artery disease[J].Echocardiography,2015,32(3):516-521.
[14]马宗仑,徐萌萌,谭丽娟,等.Rho激酶抑制剂法舒地尔对微血管心绞痛患者的疗效观察[J].岭南心血管病杂志,2015,21(5):597-600.
[15]Gurbel PA,Bliden KP,Butler K,et al.Randomized doubleblind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients w ith stable coronary artery disease:the ONSET/OFFSET study[J].Circulation,2009,120(25):2577-2585.
[16]Park SD,Lee MJ,Baek YS,et al.Randomised trial to compare a protective effect of clopidogrel versus ticagrelor on coronary microvascular injury in ST-segment elevation myocardial infarction(CV-TIM E trial)[J].Eurointervention I,2016,12(8):e964-e971.
[17]Beltrame JF,Turner SP,Leslie SL,et al.The angiographic and clinical benefits of mibefradil in the coronary slow flow phenomenon[J].J Am Coll Cardiol,2004,44(1):57-62.
[18]吴农田,李水花,樊明振.前列地尔对急性冠脉综合征PCI术后心肌灌注及心功能的影响[J].海南医学,2018,29(6):757-759.
[19]Ito N,Nanto S,Doi Y,et al.High index of microcirculatory resistance level after successful primary percutaneous coronary intervention can be improved by intracoronary administration of nicorandil[J].Circ J,2010,74(5):909-915.
[20]Garg R,Rao AD,Baimas-George M,et al.Mineralocorticoid receptor blockade improves coronary microvascular function in individuals w ith type 2 diabetes[J].Diabetes,2015,64(1):236-242.
[21]Hai-tao Z,Zhen-hua J,Jian Z,et al.No-reflow protection and long-term efficacy for acute myocardial infarction w ith Tongxinluo:a randomized double-blind placebo-controlled multicenter clinical trial(ENLEAT Trial)[J].Chin M ed J,2010,123(20):2858-2864.