Almeida Ana G
Cardiology, Heart and Vessels Department, University Hospital Santa Maria, Faculty of Medicine of Lisbon University, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal.
Curr Heart Fail Rep. 2023 Jun;20(3):139-150. doi: 10.1007/s11897-023-00605-1. Epub 2023 May 18.
Infarction (MINOCA) and ischaemia (INOCA) with non-obstructive coronary disease are recent non-conventional presentations of coronary syndromes that are increasingly recognised in the clinical arena, particularly with the availability of new cardiovascular imaging techniques. Both are related to heart failure (HF). MINOCA is not associated with benign outcomes, and HF is among the most prevalent events. Regarding INOCA, microvascular dysfunction has also been found to associate with HF, particularly with preserved ejection fraction (HFpEF).
Regardless of the several aetiologies underlying HF in MINOCA, it is likely related to LV dysfunction, where secondary prevention is not yet clearly established. Regarding INOCA, coronary microvascular ischaemia has been associated to endothelial dysfunction leading ultimately to diastolic dysfunction and HFpEF. MINOCA and INOCA are clearly related to HF. In both, there is a lack of studies on the identification of the risk factors for HF, diagnostic workup and, importantly, the appropriate primary and secondary prevention strategies.
无阻塞性冠状动脉疾病的心肌梗死（MINOCA）和心肌缺血（INOCA）是冠状动脉综合征最近出现的非传统表现形式，在临床领域越来越受到认可，尤其是随着新型心血管成像技术的出现。两者都与心力衰竭（HF）相关。MINOCA并非与良性结局相关，而HF是最常见的事件之一。关于INOCA，也发现微血管功能障碍与HF相关，特别是与射血分数保留的心力衰竭（HFpEF）相关。
无论MINOCA中心力衰竭的多种病因如何，它可能与左心室功能障碍有关，而二级预防尚未明确确立。关于INOCA，冠状动脉微血管缺血与内皮功能障碍相关，最终导致舒张功能障碍和HFpEF。MINOCA和INOCA显然与HF相关。在这两种情况中，都缺乏关于心力衰竭危险因素识别、诊断检查的研究，重要的是，缺乏适当的一级和二级预防策略的研究。
