Sidik Novalia P, McDermott Michael, McEntegart Margaret B, Berry Colin
West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Agamemnon Street, Glasgow G81 4DY, UK.
British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Eur Heart J Case Rep. 2020 Apr 24;4(3):1-6. doi: 10.1093/ehjcr/ytaa060. eCollection 2020 Jun.
Ischaemic heart disease is a leading cause of mortality in women. Even in those without obstructive coronary artery disease (CAD), women with angina continue to have increased mortality. There are gender differences in prevalence of different pathophysiologies, including functional disorders such as microvascular and vasospastic angina.
We describe four cases of angina in women with no obstructive CAD, in whom coronary function testing was performed. These four patients were diagnosed with disorders of coronary vasomotion, including vasospastic angina and different endotypes of microvascular angina.
This case series highlights the different mechanisms of ischaemia in the absence of obstructive CAD. Patients with angina and no obstructive CAD classified by computed tomography coronary angiography may have myocardial ischaemia due to microvascular angina, vasospastic angina, or both. Conventional investigations risk under-diagnosing, and as a consequence under-treating, patients with these conditions. Coronary function testing, in the form of diagnostic guidewire-based tests and adjunctive acetylcholine provocation, has proven to be critical in the accurate diagnoses and appropriate management of these patients.
缺血性心脏病是女性死亡的主要原因。即使在没有阻塞性冠状动脉疾病（CAD）的女性中，患有心绞痛的女性死亡率仍持续上升。不同病理生理学的患病率存在性别差异，包括微血管性和血管痉挛性心绞痛等功能性障碍。
我们描述了4例无阻塞性CAD的女性心绞痛病例，并对其进行了冠状动脉功能测试。这4例患者被诊断为冠状动脉血管运动障碍，包括血管痉挛性心绞痛和不同亚型的微血管性心绞痛。
该病例系列突出了无阻塞性CAD时缺血的不同机制。经计算机断层扫描冠状动脉造影分类为无阻塞性CAD的心绞痛患者，可能因微血管性心绞痛、血管痉挛性心绞痛或两者兼有而出现心肌缺血。传统检查有漏诊这些疾病患者的风险，从而导致治疗不足。基于诊断导丝的测试及辅助乙酰胆碱激发试验形式的冠状动脉功能测试，已被证明对准确诊断和合理治疗这些患者至关重要。
