Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
Rev Port Cardiol. 2023 May;42(5):455-465. doi: 10.1016/j.repc.2022.05.011. Epub 2023 Feb 23.
Coronary vasomotion disorders (CVDs), including microvascular angina (MVA) and vasospastic angina (VSA), account for significant morbidity among patients with non-obstructive coronary artery disease (NOCAD). However, protocols for CVD assessment in clinical practice are seldom standardized and may be difficult to implement.
To assess the safety and feasibility of a comprehensive coronary function test (CFT) protocol for assessment of CVD and the prevalence of different phenotypes of CVD in patients with angina and NOCAD (ANOCA).
Patients with persistent angina referred for invasive coronary angiogram and found to have NOCAD were prospectively recruited and underwent a CFT. Functional parameters (fractional flow reserve, coronary flow reserve and index of myocardial resistance) and coronary vasoreactivity were assessed in all patients.
Of the 20 patients included, the mean age was 63±13 years and 50% were females. Most patients had persistent typical angina and evidence of ischemia in noninvasive tests (75%). The CFT was successfully performed in all subjects without serious complications. Isolated MVA was found in 25%, isolated VSA in 40%, both MVA and VSA in 10% and noncardiac chest pain in 25% of patients. Antianginal therapy was modified after the results of CFT in 70% of patients.
A coronary function test was feasible and safe in a cohort of patients with ANOCA. CVD were prevalent in this selected group of patients, and some presented mixed CVD phenotypes. CFT may provide a definitive diagnosis in patients with persistent angina and prompt the stratification of pharmacological therapy.
冠状动脉舒缩功能障碍（CVDs），包括微血管性心绞痛（MVA）和痉挛性心绞痛（VSA），在非阻塞性冠状动脉疾病（NOCAD）患者中发病率较高。然而，目前在临床实践中，CVD 的评估方案很少标准化，可能难以实施。
评估综合冠状动脉功能测试（CFT）方案评估 CVD 以及心绞痛和 NOCAD（ANOCA）患者中不同 CVD 表型患病率的安全性和可行性。
前瞻性招募持续性心绞痛并经侵入性冠状动脉造影检查发现 NOCAD 的患者，并进行 CFT。所有患者均评估功能参数（血流储备分数、冠状动脉血流储备和心肌阻力指数）和冠状动脉反应性。
20 例患者中，平均年龄为 63±13 岁，50%为女性。大多数患者有持续性典型心绞痛和非侵入性检查的缺血证据（75%）。所有患者均成功完成 CFT，无严重并发症。25%的患者存在孤立性 MVA，40%的患者存在孤立性 VSA，10%的患者存在 MVA 和 VSA 并存，25%的患者存在非心源性胸痛。70%的患者在 CFT 结果后调整了抗心绞痛治疗。
在一组 ANOCA 患者中，冠状动脉功能测试是可行和安全的。在这组选定的患者中，CVD 较为常见，一些患者存在混合 CVD 表型。CFT 可能为持续性心绞痛患者提供明确诊断，并为药物治疗分层提供依据。
