Meeder Joan G, Hartzema-Meijer Mariëlle J, Jansen Tijn P J, Konst Regina E, Damman Peter, Elias-Smale Suzette E
Department of Cardiology, VieCuri Medical Center, Venlo, Netherlands.
Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands.
Front Cardiovasc Med. 2021 Nov 2;8:716319. doi: 10.3389/fcvm.2021.716319. eCollection 2021.
Two-thirds of women and one-third of men who undergo a clinically indicated coronary angiography for stable angina, have no obstructive coronary artery disease (CAD). Coronary vascular dysfunction is a highly prevalent underlying cause of angina in these so called "Angina with No Obstructive Coronary Arteries (ANOCA)" patients, foremost in middle aged women. Coronary vascular dysfunction encompasses various endotypes, namely epicardial and microvascular coronary spasms, impaired vasodilatation, and increased microvascular resistance. ANOCA patients, especially those with underlying coronary vascular dysfunction, have an adverse cardiovascular prognosis, poor physical functioning, and a reduced quality of life. Since standard ischemia detection tests and coronary angiograms are not designed to diagnose coronary vascular dysfunction, this ischemic heart disease is often overlooked and hence undertreated. But adequate diagnosis is vital, so that treatment can be started to reduce symptoms, reduce healthcare costs and improve quality of life and cardiovascular prognosis. The purpose of this review is to give a contemporary overview of ANOCA with focus on coronary vascular dysfunction. We will provide a possible work-up of patients suspected of coronary vascular dysfunction in the outpatient clinical setting, based on the latest scientific insights and international consensus documents. We will discuss the value of ischemia detection testing, and non-invasive and invasive methods to diagnose coronary vascular dysfunction. Furthermore, we will go into pharmacological and non-pharmacological therapeutic options including anti-anginal regimens and lifestyle interventions.
因稳定型心绞痛接受临床指征性冠状动脉造影的女性患者中有三分之二、男性患者中有三分之一没有阻塞性冠状动脉疾病（CAD）。在这些所谓的“无阻塞性冠状动脉的心绞痛（ANOCA）”患者中，冠状动脉血管功能障碍是心绞痛的一个高度普遍的潜在原因，在中年女性中最为常见。冠状动脉血管功能障碍包括多种亚型，即心外膜和微血管冠状动脉痉挛、血管舒张受损以及微血管阻力增加。ANOCA患者，尤其是那些存在潜在冠状动脉血管功能障碍的患者，心血管预后不良、身体功能差且生活质量降低。由于标准的缺血检测试验和冠状动脉造影并非用于诊断冠状动脉血管功能障碍，这种缺血性心脏病常常被忽视，因此治疗不足。但准确诊断至关重要，这样才能开始治疗以减轻症状、降低医疗成本并改善生活质量和心血管预后。本综述的目的是对ANOCA进行当代概述，重点关注冠状动脉血管功能障碍。我们将根据最新的科学见解和国际共识文件，提供在门诊临床环境中对疑似冠状动脉血管功能障碍患者的可能检查方法。我们将讨论缺血检测试验以及诊断冠状动脉血管功能障碍的非侵入性和侵入性方法的价值。此外，我们将探讨包括抗心绞痛方案和生活方式干预在内的药物和非药物治疗选择。
