Zhou Jinying, Onuma Yoshinobu, Garg Scot, Kotoku Nozomi, Kageyama Shigetaka, Masuda Shinichiro, Ninomiya Kai, Huo Yunlong, Reiber Johan H C, Tu Shengxian, Piek Jan J, Escaned Javier, Perera Divaka, Bourantas Christos, Yan Hongbing, W Serruys Patrick
National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Xicheng, Beijing, China.
Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland.
Expert Rev Cardiovasc Ther. 2022 Jul;20(7):549-566. doi: 10.1080/14779072.2022.2098117. Epub 2022 Aug 9.
Non-obstructive coronary arteries (NOCA) are present in 39.7% to 62.4% of patients who undergo elective angiography. Coronary microcirculation (<400 µm) is not visible on angiography therefore functional assessment, invasive or noninvasive plays a prior role to help provide a more personalized diagnosis of angina.
In this review, we revisit the pathophysiology, clinical importance, and invasive assessment of the coronary microcirculation, and discuss angiography-derived indices of microvascular resistance. A comprehensive literature review over four decades is also undertaken.
The coronary microvasculature plays an important role in flow autoregulation and metabolic regulation. Invasive assessment of microvascular resistance is a validated modality with independent prognostic value, nevertheless, its routine application is hampered by the requirement of intravascular instrumentation and hyperemic agents. The angiography-derived index of microvascular resistance has emerged as a promising surrogate in pilot studies, however, more data are needed to validate and compare the diagnostic and prognostic accuracy of different equations as well as to illustrate the relationship between angiography-derived parameters for epicardial coronary arteries and those for the microvasculature.
在接受选择性血管造影的患者中，39.7%至62.4%存在非阻塞性冠状动脉（NOCA）。冠状动脉微循环（<400 µm）在血管造影中不可见，因此功能评估，无论是有创还是无创，对于帮助提供更个性化的心绞痛诊断都起着首要作用。
在本综述中，我们重新审视冠状动脉微循环的病理生理学、临床重要性和有创评估，并讨论血管造影衍生的微血管阻力指标。我们还对四十年来的文献进行了全面综述。
冠状动脉微血管系统在血流自动调节和代谢调节中起重要作用。微血管阻力的有创评估是一种经过验证的方法，具有独立的预后价值，然而，其常规应用受到血管内仪器和充血剂需求的阻碍。血管造影衍生的微血管阻力指标在初步研究中已成为一种有前景的替代指标，但是，需要更多数据来验证和比较不同方程的诊断和预后准确性，以及说明心外膜冠状动脉和微血管系统的血管造影衍生参数之间的关系。
