van der Meer Roos Et, Maas Angela Hem
Utrecht University Utrecht, the Netherlands.
Department of Cardiology, Radboud University Medical Center Nijmegen, the Netherlands.
Eur Cardiol. 2021 Oct 12;16:e37. doi: 10.15420/ecr.2021.20. eCollection 2021 Feb.
Ischaemic heart disease has been estimated to affect 126.5 million people globally. Approximately 70% of patients with angina and suspected myocardial ischaemia show no signs of obstructed coronary arteries after coronary angiography, but may still demonstrate ischaemia. Ischaemia with no obstructive coronary artery disease (INOCA) is increasingly acknowledged as a serious condition because of its association with poor quality of life and elevated risk for cardiovascular events. The negative effects of psychological stress on INOCA are gaining more attention. Psychological stress is associated with adverse cardiovascular outcomes such as mental stress-induced myocardial ischaemia. Psychological stress includes anxiety, depression, anger and personality disturbances. Coronary microvascular dysfunction and coronary arterial spasm are phenotypes of coronary vasomotor disorders that are triggered by psychological distress and depression, thereby increasing cardiovascular disease risk. Coronary vasomotor disorders are often co-existent in INOCA patients and might be considered as a contributing factor to mental stress-associated adverse cardiovascular outcomes. Additionally, psychological stress induces endothelial dysfunction more often in (young) women with INOCA than in men. Overall, many studies demonstrate an association between mental stress, coronary microvascular dysfunction and coronary vasospasm in patients with INOCA - especially women. Future research on stress-reducing therapies that target coronary vasomotor disorders in patients with INOCA is needed. This is particularly the case in young adolescents, in whom this type of ischaemic heart disease is increasing.
据估计，全球有1.265亿人患有缺血性心脏病。在心绞痛和疑似心肌缺血患者中，约70%的人在冠状动脉造影后未显示冠状动脉阻塞迹象，但仍可能表现出缺血症状。无阻塞性冠状动脉疾病的缺血（INOCA）越来越被认为是一种严重疾病，因为它与生活质量差和心血管事件风险升高有关。心理压力对INOCA的负面影响越来越受到关注。心理压力与不良心血管结局相关，如精神压力诱发的心肌缺血。心理压力包括焦虑、抑郁、愤怒和人格障碍。冠状动脉微血管功能障碍和冠状动脉痉挛是冠状动脉血管舒缩障碍的表型，由心理困扰和抑郁引发，从而增加心血管疾病风险。冠状动脉血管舒缩障碍在INOCA患者中常并存，可能被视为与精神压力相关的不良心血管结局的一个促成因素。此外，心理压力在患有INOCA的（年轻）女性中比在男性中更常诱发内皮功能障碍。总体而言，许多研究表明，在INOCA患者中，尤其是女性，精神压力、冠状动脉微血管功能障碍和冠状动脉痉挛之间存在关联。需要针对INOCA患者冠状动脉血管舒缩障碍的减压疗法进行未来研究。在青少年中尤其如此，这类缺血性心脏病在青少年中的发病率正在上升。
