Chierchia S L, Fragasso G
Department of Cardiology, Istituto Scientifico H San Raffaele, Milano, Italy.
Eur Heart J. 1996 Dec;17 Suppl G:14-9. doi: 10.1093/eurheartj/17.suppl_g.14.
Approximately 20% of patients undergoing diagnostic coronary arteriography for acute or chronic cardiac ischaemia have angiographically normal coronary arteries. The mechanism behind this phenomenon is likely to be the result of a combination of functional or anatomical abnormalities in the coronary microcirculation, a metabolic disorder which affects the handling of energy substrates by the heart, insulin resistance and a neurological component affecting pain perception. Indeed, it has been demonstrated that these patients often exhibit an increase in sympathetic outflow to the cardiovascular system, which might account for the reduction in coronary flow reserve, changes in metabolic utilization and development of insulin resistance that are seen in some of these patients. Therapeutically, beta-blockers appear to be most effective in controlling the symptoms associated with this condition, although those calcium antagonists which do not affect the neurohormonal system may be of some utility in patients with primary microvascular angina, in which microvascular spasm is operating or in whom excessive constriction of the distal component of the coronary circulation limits the vasodilatory reserve.
因急性或慢性心脏缺血而接受诊断性冠状动脉造影的患者中，约20%的人冠状动脉造影显示正常。这种现象背后的机制可能是冠状动脉微循环功能或解剖异常、影响心脏能量底物处理的代谢紊乱、胰岛素抵抗以及影响疼痛感知的神经因素共同作用的结果。事实上，已经证明这些患者常常表现出心血管系统交感神经输出增加，这可能解释了其中一些患者出现的冠状动脉血流储备减少、代谢利用变化以及胰岛素抵抗的发生。在治疗方面，β受体阻滞剂似乎在控制与这种情况相关的症状方面最为有效，尽管那些不影响神经激素系统的钙拮抗剂可能对原发性微血管性心绞痛患者有一定作用，在原发性微血管性心绞痛中，微血管痉挛起作用，或者冠状动脉循环远端成分过度收缩限制了血管舒张储备。
