Buonpane Angela, De Caterina Alberto Ranieri, Trimarchi Giancarlo, Di Muro Francesca Maria, Galante Domenico, Zella Samuela, Pizzino Fausto, Ciardetti Marco, Paradossi Umberto, Concistrè Giovanni, Berti Sergio, Leone Antonio Maria, Crea Filippo, Trani Carlo, Burzotta Francesco
Ospedale Isola Tiberina-Gemelli Isola, 00186 Rome, Italy.
Fondazione Toscana G. Monasterio, Ospedale del Cuore G, Pasquinucci, 54100 Massa, Italy.
Medicina (Kaunas). 2025 Jul 4;61(7):1218. doi: 10.3390/medicina61071218.
Despite significant advances in understanding and management, cardiovascular diseases remain the leading cause of mortality worldwide. Historically, diagnostic and therapeutic strategies have typically targeted obstructive coronary arteries. However, growing evidence supports the pivotal role of non-obstructive mechanisms in myocardial ischemia, prompting a new classification that distinguishes Acute Myocardial Ischemic Syndromes from Non-Acute Myocardial Ischemic Syndromes. In this evolving context, Optical Coherence Tomography (OCT) plays an important diagnostic role in the assessment of both obstructive and non-obstructive ischemic mechanisms. In Acute Myocardial Ischemic Syndromes, OCT enables the identification of major plaque destabilization mechanisms and contributes to the diagnosis of Myocardial Infarction with Non-Obstructive Coronary Arteries, helping to differentiate between atherosclerotic and non-atherosclerotic causes. In Non-Acute Myocardial Ischemic Syndromes, OCT assists in evaluating stenosis severity, plaque morphology, vulnerability, and healing, and may contribute to the diagnosis of Ischemia with Non-Obstructive Coronary Arteries, identifying myocardial bridge and epicardial spasm alongside conventional functional assessment of intermediate stenoses. This narrative review outlines the expanding clinical applications of OCT across the full spectrum of ischemic syndromes, emphasizing its role in bridging obstructive and non-obstructive pathophysiology and supporting a more comprehensive diagnostic approach to ischemic heart disease.
尽管在理解和管理方面取得了重大进展，但心血管疾病仍然是全球主要的死亡原因。从历史上看，诊断和治疗策略通常针对阻塞性冠状动脉。然而，越来越多的证据支持非阻塞性机制在心肌缺血中的关键作用，促使一种新的分类方法将急性心肌缺血综合征与非急性心肌缺血综合征区分开来。在这种不断演变的背景下，光学相干断层扫描（OCT）在评估阻塞性和非阻塞性缺血机制方面发挥着重要的诊断作用。在急性心肌缺血综合征中，OCT能够识别主要的斑块不稳定机制，并有助于诊断非阻塞性冠状动脉心肌梗死，有助于区分动脉粥样硬化和非动脉粥样硬化原因。在非急性心肌缺血综合征中，OCT有助于评估狭窄严重程度、斑块形态、易损性和愈合情况，并可能有助于诊断非阻塞性冠状动脉缺血，除了对中度狭窄进行传统功能评估外，还能识别心肌桥和心外膜痉挛。这篇叙述性综述概述了OCT在整个缺血综合征范围内不断扩大的临床应用，强调其在连接阻塞性和非阻塞性病理生理学方面的作用，并支持对缺血性心脏病采取更全面的诊断方法。
