Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.
Institute of Cardiology and Center of Excellence on Aging, "G. d'Annunzio" University, Chieti, Italy.
JACC Cardiovasc Interv. 2014 May;7(5):453-63. doi: 10.1016/j.jcin.2014.01.157. Epub 2014 Apr 16.
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.
心绞痛和非阻塞性冠状动脉疾病相关性心肌缺血是常见的临床发现，通常由于预后良好的假设而被忽视。此类患者多数既未接受进一步检查，也未获得除了安慰之外的特定治疗。然而，冠状动脉造影上不存在显著的冠状动脉狭窄并不一定意味着冠状动脉树是“健康”的。在这种情况下，心肌缺血可能源于涉及心外膜冠状动脉、冠状动脉微循环或两者的不同类型的功能性疾病；在排除器质性心外膜疾病后，应系统地评估这些成分，因为正确的诊断具有重要的预后和治疗意义。在这里，我们讨论了在这种情况下诊断测试的基本原则，并提出了一种合理实用的诊断顺序，有助于识别有未来心脏事件风险的患者。
