Shome Joy S, Perera Divaka, Plein Sven, Chiribiri Amedeo
Division of Imaging Sciences and Biomedical Engineering, The Rayne Institute, King's College London, St. Thomas' Hospital, London, UK.
Cardiovascular Division, The Rayne Institute, King's College London, St. Thomas' Hospital, London, UK.
Microcirculation. 2017 Jan;24(1). doi: 10.1111/micc.12340.
The coronary arterial system consists of large epicardial coronary arteries, pre-arterioles, and arterioles, which together closely regulate CBF. Structural, functional, and extravascular abnormalities of the microcirculation lead to CMD. CMD can present with symptoms suggestive of CAD, often in the absence of significant obstructive epicardial CAD. Conventional invasive angiography does not allow direct visualization of the microcirculation. Invasive indices, such as CBF and CFR, and non-invasive imaging modalities, such as CMR and PET, can be used to quantify absolute MBF and enable a direct and accurate assessment of coronary microvascular function. CMD appears to be more prevalent in women, typically presenting with symptoms of ischemia with unobstructed coronary arteries, and has a relatively unfavorable prognosis. CMD is classified clinically depending on the presence or absence of epicardial CAD, myocardial disease, or iatrogenic causes. Although invasive intracoronary techniques can be used to detect CMD, these cannot provide insight into the mechanisms involved in its pathogenesis. Imaging modalities such as CMR and cardiac PET are becoming indispensable tools in the evaluation of suspected CMD.
冠状动脉系统由大的心外膜冠状动脉、前小动脉和小动脉组成，它们共同紧密调节冠状动脉血流量（CBF）。微循环的结构、功能及血管外异常会导致冠状动脉微血管疾病（CMD）。CMD可能表现出提示冠心病（CAD）的症状，通常在不存在明显阻塞性心外膜CAD的情况下出现。传统的有创血管造影无法直接观察微循环。诸如CBF和冠状动脉血流储备（CFR）等有创指标，以及诸如心脏磁共振成像（CMR）和正电子发射断层扫描（PET）等无创成像方式，可用于量化绝对心肌血流量（MBF），并能直接准确地评估冠状动脉微血管功能。CMD在女性中似乎更为普遍，通常表现为冠状动脉通畅时的缺血症状，且预后相对较差。CMD根据是否存在心外膜CAD、心肌病或医源性病因进行临床分类。尽管有创冠状动脉内技术可用于检测CMD，但这些技术无法深入了解其发病机制中涉及的机制。诸如CMR和心脏PET等成像方式正成为评估疑似CMD时不可或缺的工具。
