冠状动脉内皮功能障碍:在患有非阻塞性胸痛的患者中,诊断的必要性还是徒劳的努力?
Johanna McChord1, Astrid Hubert1, Leonie Saccardi1
1Department of Cardiology and Angiology, Robert Bosch Hospital, Stuttgart, Germany.
概括
内皮功能障碍 (ED) 在无阻塞性冠状动脉疾病 (ANOCA) 的心痛中很常见,但很少被孤立. 综合性冠状动脉功能测试应优先考虑和微血管功能障碍,而不是ED评估.
科学领域:
- 心脏病学 心脏病学
- 血管生物学 血管生物学
- 诊断成像 诊断成像 诊断成像
背景情况:
- 缺少阻塞性冠状动脉疾病 (ANOCA) 的心痛经常与内皮功能障碍 (ED),冠状动脉微血管功能障碍 (CMD) 和冠状动脉有关.
- 内皮功能障碍的特征是冠状动脉血流的有限增加 (<50%) 或表心动脉狭窄,以应对低剂量乙胆 (ACh).
- 孤立性ED的患病率和临床意义尚未得到充分确立.
研究的目的:
- 为了确定ANOCA患者中ED的患病率.
- 在综合冠状动脉功能测试 (CFT) 中评估ED评估的诊断实用性.
主要方法:
- 80名ANOCA患者接受了侵袭性冠状动脉血管造影,并进行低剂量和高剂量ACH测试.
- 测量了冠状动脉血流 (CBF),定量冠状动脉血管学 (QCA) 评估了冠状动脉直径.
- 冠状动脉微血管功能障碍 (CMD) 定义为冠状动脉流量储备 (CFR) <2.5和/或高血压微血管抵抗 (HMR) >2.5;冠状动脉根据COVADIS标准诊断.
主要成果:
- 内皮功能障碍 (ED) 在84%的患者中被发现;冠状动脉在80%中,CMD在45%中.
- 联合和CMD测试产生了90%的诊断率,达到100%的ED评估.
- 所有没有CMD或的患者都表现出ED,只有10%的患者有孤立的ED. 值得注意的是,27%的ED患者在低剂量ACH时也出现了.
结论:
- 内皮功能障碍 (ED) 在ANOCA中非常普遍,但很少单独发生.
- 鉴于ED测试所付出的巨大努力,以及其对CFT诊断产量的微不足道增加,建议优先考虑和CMD评估.
- 综合性测试至关重要,因为一些ED患者即使在低剂量乙胆时也会出现.
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