Indolfi Ciro, Porto Italo, Muscoli Saverio, Fedele Francesco, Mancone Massimo
Istituto di Cardiologia, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi "Magna Graecia", Catanzaro.
Dipartimento di Medicina Interna e Specialità Mediche - DiMI, Università degli Studi, Genova, e U.O.C. Clinica delle Malattie Cardiovascolari, Dipartimento CardioToracoVascolare (DICATOV), Ospedale Policlinico San Martino IRCCS, Genova.
G Ital Cardiol (Rome). 2022 Jun;23(6):397-407. doi: 10.1714/3810.37933.
A large percentage of patients, predominantly female, who undergo coronary angiography for typical chest pain do not have significant coronary stenosis. Many of these patients with microvascular myocardial disease have left ventricular hypertrophy, cardiomyopathies, valve disease, or other clinical conditions. The definition of microvascular angina is based on (i) symptoms of myocardial ischemia, (ii) absence of obstructive coronary artery disease (<50% stenosis on coronary angiography or coronary computed tomography scan), (iii) objective evidence of myocardial ischemia (ischemic electrocardiographic abnormalities during episodes of chest pain and/or myocardial perfusion defects or regional contractility abnormalities), and (iv) pathological indices of microcirculation (index of microcirculatory resistance >25, coronary flow reserve <2.0) and/or microvascular spasm (TIMI flow <2) during intracoronary vasoreactivity tests. The basic mechanisms and the diagnostic tests of microvascular dysfunction are reported in detail.From a clinical standpoint, while the crucial role of microcirculation in determining short- and long-term prognosis is evident, efforts to date to improve clinical outcomes in patients with microvascular obstruction have had limited success, most likely because microvascular dysfunction is a multifactorial process with several interdependent underlying pathophysiological mechanisms. Therefore, further studies are needed to develop effective therapeutic strategies for microvascular myocardial disease.
很大比例的患者（主要为女性）因典型胸痛接受冠状动脉造影检查，结果显示并无明显的冠状动脉狭窄。这些患有微血管性心肌疾病的患者中，许多人还伴有左心室肥厚、心肌病、瓣膜病或其他临床病症。微血管性心绞痛的定义基于以下几点：（i）心肌缺血症状；（ii）无阻塞性冠状动脉疾病（冠状动脉造影或冠状动脉计算机断层扫描显示狭窄<50%）；（iii）心肌缺血的客观证据（胸痛发作时出现缺血性心电图异常和/或心肌灌注缺损或局部收缩功能异常）；（iv）冠状动脉血管反应性测试期间的微循环病理指标（微循环阻力指数>25，冠状动脉血流储备<2.0）和/或微血管痉挛（心肌梗死溶栓试验血流分级<2级）。本文详细报道了微血管功能障碍的基本机制和诊断测试。从临床角度来看，虽然微循环在决定短期和长期预后方面的关键作用是显而易见的，但迄今为止，改善微血管阻塞患者临床结局的努力成效有限，这很可能是因为微血管功能障碍是一个多因素过程，存在多种相互依存的潜在病理生理机制。因此，需要进一步开展研究，以制定针对微血管性心肌疾病的有效治疗策略。
