British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Golden Jubilee National Hospital, Clydebank, UK.
Cardiovasc Drugs Ther. 2022 Oct;36(5):1027-1038. doi: 10.1007/s10557-021-07179-x. Epub 2021 May 12.
Ischemic heart disease (IHD) is a leading global cause of ill-health and premature death. Clinical research into IHD is providing new insights into the pathophysiology, epidemiology and treatment of this condition. The major endotypes of IHD include coronary heart disease (CHD) and vasomotor disorders, including microvascular angina and vasospastic angina. Considering unselected patients presenting with stable chest pain, the pre-test probability of CHD is higher in men whereas the pre-test probability of a vasomotor disorder is higher in women. The diagnostic accuracy of diagnostic tests designed to assess coronary anatomy and disease and/or coronary vascular function (functional tests) differ for coronary endotypes. Clinical management should therefore be personalized and take account of sex-related factors. In this review, we consider the definitions of angina and myocardial ischemia. We then appraise the mechanistic links between myocardial ischemia and anginal symptoms and the relative merits of non-invasive and invasive diagnostic tests and related clinical management. Finally, we describe the rationale and importance of stratified medicine of IHD.
缺血性心脏病（IHD）是全球主要的健康不良和早逝原因。IHD 的临床研究为这种疾病的病理生理学、流行病学和治疗提供了新的见解。IHD 的主要亚型包括冠心病（CHD）和血管舒缩障碍，包括微血管性心绞痛和血管痉挛性心绞痛。考虑到出现稳定胸痛的未经选择的患者，CHD 的预测试验概率在男性中更高，而血管舒缩障碍的预测试验概率在女性中更高。旨在评估冠状动脉解剖结构和疾病以及/或冠状动脉血管功能的诊断性检查（功能检查）的诊断准确性因冠状动脉亚型而异。因此，临床管理应该个性化，并考虑与性别相关的因素。在这篇综述中，我们考虑了心绞痛和心肌缺血的定义。然后，我们评估了心肌缺血与心绞痛症状之间的机制联系，以及非侵入性和侵入性诊断性检查的相对优点以及相关的临床管理。最后，我们描述了 IHD 分层医学的原理和重要性。
