Ong Peter, Sechtem Udo
Dtsch Med Wochenschr. 2017 Oct;142(21):1586-1593. doi: 10.1055/s-0043-104469. Epub 2017 Oct 18.
Patients with microvascular angina are characterized by angina pectoris with proof of myocardial ischemia in the absence of any relevant epicardial stenosis and without myocardial disease (type 1 coronary microvascular dysfunction according to Crea and Camici). Structural and functional alterations of the coronary microvessels (diameter < 500 µm) are the reason for this phenomenon. Frequently such alterations are associated with cardiovascular risk factors. Patients with angina pectoris without epicardial stenoses represent for 10 - 50 % of all patients undergoing coronary angiography depending on the clinical presentation. Diagnostic approaches include non-invasive (e. g. combination of coronary CT-angiography and positron emission tomography/echo Doppler-based coronary flow reserve measurements) as well as invasive procedures (coronary flow reserve measurements in response to adenosine, intracoronary acetylcholine testing). Pharmacological treatment of these patients is often challenging and should be based on the characterization of the underlying mechanisms. Moreover, strict risk factor control and individually titrated combinations of antianginal substances (e. g. beta blockers, calcium channel blockers, nitrates, ranolazine, ivabradine etc.) are recommended.
微血管性心绞痛患者的特征为患有心绞痛且有心肌缺血证据，但不存在任何相关的心外膜狭窄且无心肌疾病（根据克雷亚和卡米西的分类为1型冠状动脉微血管功能障碍）。冠状动脉微血管（直径<500μm）的结构和功能改变是这一现象的原因。此类改变常与心血管危险因素相关。无心外膜狭窄的心绞痛患者占接受冠状动脉造影的所有患者的10%-50%，具体比例取决于临床表现。诊断方法包括非侵入性方法（例如冠状动脉CT血管造影与正电子发射断层扫描/基于超声多普勒的冠状动脉血流储备测量相结合）以及侵入性操作（腺苷激发下的冠状动脉血流储备测量、冠状动脉内乙酰胆碱试验）。对这些患者进行药物治疗往往具有挑战性，应基于对潜在机制的特征分析。此外，建议严格控制危险因素，并个体化滴定抗心绞痛药物（例如β受体阻滞剂、钙通道阻滞剂、硝酸盐、雷诺嗪、伊伐布雷定等）的联合使用。
