Cianflone D, Lanza G A, Maseri A
Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma, Italy.
Eur Heart J. 1995 Aug;16 Suppl I:96-103. doi: 10.1093/eurheartj/16.suppl_i.96.
In this paper we review the evidence that angina and 'ischaemic' ST depression can be caused by inappropriate constriction of small coronary artery vessels in patients with microvascular angina (i.e. anginal chest pain with angiographically normal coronary arteries). Although the mechanisms responsible for microvascular dysfunction remain unknown, it is conceivable that the constrictor stimuli may involve vessels which are proximal to those involved in metabolically induced dilation, so that the effect cannot be opposed, at the same site, by the dilator effect caused by ischaemic metabolites. Furthermore, in this review we also present evidence that myocardial ischaemia may result mainly from inappropriate constriction of small coronary vessels, rather than by obstruction of major epicardial coronary arteries. In addition, there are those prone to the condition, such as specific groups of patients with atherosclerotic ischaemic syndromes, including patients with single isolated coronary artery occlusion and no evidence of previous myocardial infarction, patients with single-vessel coronary stenosis who underwent successful balloon angioplasty, and patients with single-vessel disease with detectable abnormal vasomotor responses in non-stenotic coronary arteries.
在本文中，我们回顾了微血管性心绞痛（即冠状动脉造影正常但有胸痛症状）患者中，心绞痛和“缺血性”ST段压低可能由小冠状动脉血管不适当收缩引起的证据。尽管微血管功能障碍的机制尚不清楚，但可以想象，收缩刺激可能涉及比代谢诱导扩张所涉及的血管更靠近近端的血管，因此在同一部位，缺血代谢产物引起的扩张效应无法对抗这种收缩效应。此外，在本综述中，我们还提供证据表明，心肌缺血可能主要源于小冠状动脉的不适当收缩，而非主要的心外膜冠状动脉阻塞。另外，还有一些人容易患这种疾病，比如特定的动脉粥样硬化缺血综合征患者群体，包括孤立性单支冠状动脉闭塞且无既往心肌梗死证据的患者、接受成功球囊血管成形术的单支冠状动脉狭窄患者，以及在非狭窄冠状动脉中可检测到异常血管运动反应的单支血管疾病患者。
