Zhan Junzhen, Zhong Longhe, Wu Juefei
Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Front Cardiovasc Med. 2022 Jun 20;9:899099. doi: 10.3389/fcvm.2022.899099. eCollection 2022.
With growing evidence in clinical practice, the understanding of coronary syndromes has gradually evolved out of focusing on the well-established link between stenosis of epicardial coronary artery and myocardial ischemia to the structural and functional abnormalities at the level of coronary microcirculation, known as coronary microvascular dysfunction (CMD). CMD encompasses several pathophysiological mechanisms of coronary microcirculation and is considered as an important cause of myocardial ischemia in patients with angina symptoms without obstructive coronary artery disease (CAD). As a result of growing knowledge of the understanding of CMD assessed by multiple non-invasive modalities, CMD has also been found to be involved in other cardiovascular diseases, including primary cardiomyopathies as well as heart failure with preserved ejection fraction (HFpEF). In the past 2 decades, almost all the imaging modalities have been used to non-invasively quantify myocardial blood flow (MBF) and promote a better understanding of CMD. Myocardial contrast echocardiography (MCE) is a breakthrough as a non-invasive technique, which enables assessment of myocardial perfusion and quantification of MBF, exhibiting promising diagnostic performances that were comparable to other non-invasive techniques. With unique advantages over other non-invasive techniques, MCE has gradually developed into a novel modality for assessment of the coronary microvasculature, which may provide novel insights into the pathophysiological role of CMD in different clinical conditions. Moreover, the sonothrombolysis and the application of artificial intelligence (AI) will offer the opportunity to extend the use of contrast ultrasound theragnostics.
随着临床实践中证据的不断增加，对冠状动脉综合征的认识已逐渐从关注心外膜冠状动脉狭窄与心肌缺血之间已确立的联系，发展到关注冠状动脉微循环水平的结构和功能异常，即冠状动脉微血管功能障碍（CMD）。CMD涵盖冠状动脉微循环的多种病理生理机制，被认为是无阻塞性冠状动脉疾病（CAD）但有胸痛症状患者心肌缺血的重要原因。由于通过多种非侵入性方法对CMD的认识不断增加，CMD也被发现与其他心血管疾病有关，包括原发性心肌病以及射血分数保留的心力衰竭（HFpEF）。在过去20年中，几乎所有成像方法都被用于非侵入性定量心肌血流量（MBF），并促进了对CMD的更好理解。心肌对比超声心动图（MCE）作为一种非侵入性技术是一项突破，它能够评估心肌灌注并定量MBF，其诊断性能与其他非侵入性技术相当，展现出良好前景。MCE相对于其他非侵入性技术具有独特优势，已逐渐发展成为评估冠状动脉微血管的一种新方法，这可能为CMD在不同临床情况下的病理生理作用提供新见解。此外，超声溶栓和人工智能（AI）的应用将为扩展超声造影诊断治疗的应用提供机会。
