Bairey Merz C Noel, Pepine Carl J, Walsh Mary Norine, Fleg Jerome L
From Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (C.N.B.M.); Division of Cardiology, University of Florida, Gainesville (C.J.P.); St. Vincent Heart Transplant, Indianapolis, IN (M.N.W.); and National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.).
Circulation. 2017 Mar 14;135(11):1075-1092. doi: 10.1161/CIRCULATIONAHA.116.024534.
The Cardiovascular Disease in Women Committee of the American College of Cardiology, in conjunction with interested parties (from the National Heart, Lung, and Blood Institute, American Heart Association, and European Society of Cardiology), convened a working group to develop a consensus on the syndrome of myocardial ischemia with no obstructive coronary arteries. In general, these patients have elevated risk for a cardiovascular event (including acute coronary syndrome, heart failure hospitalization, stroke, and repeat cardiovascular procedures) compared with reference subjects and appear to be at higher risk for development of heart failure with preserved ejection fraction. A subgroup of these patients also has coronary microvascular dysfunction and evidence of inflammation. This document provides a summary of findings and recommendations for the development of an integrated approach for identifying and managing patients with ischemia with no obstructive coronary arteries and outlines knowledge gaps in the area. Working group members critically reviewed available literature and current practices for risk assessment and state-of-the-science techniques in multiple areas, with a focus on next steps needed to develop evidence-based therapies. This report presents highlights of this working group review and a summary of suggested research directions to advance this field in the next decade.
美国心脏病学会女性心血管疾病委员会与相关方（来自美国国立心肺血液研究所、美国心脏协会和欧洲心脏病学会）联合召集了一个工作组，就无阻塞性冠状动脉的心肌缺血综合征达成共识。总体而言，与参照对象相比，这些患者发生心血管事件（包括急性冠状动脉综合征、心力衰竭住院、中风和重复心血管手术）的风险更高，并且发生射血分数保留的心力衰竭的风险似乎也更高。这些患者中的一个亚组还存在冠状动脉微血管功能障碍和炎症证据。本文档总结了研究结果，并就制定识别和管理无阻塞性冠状动脉缺血患者的综合方法提出了建议，同时概述了该领域的知识空白。工作组成员严格审查了现有文献以及多个领域风险评估和科学技术现状的当前实践，重点关注开发循证疗法所需的后续步骤。本报告介绍了该工作组成员审查的要点以及为在未来十年推动该领域发展而建议的研究方向总结。
