弥合差距:在临床实践中评估冠状动脉微循环的综合工具包
Alberto Polimeni1,2, Roberto Scarsini3, Marta Belmonte4,5
1Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy.
American journal of physiology. Heart and circulatory physiology
|December 23, 2025
概括
冠状动脉疾病 (CAD) 诊断正在从心上动脉转移到冠状动脉微循环. 新的侵入性和非侵入性工具现在允许对冠状动脉微血管功能障碍 (CMD) 进行全面评估,改善患者护理.
科学领域:
- 心脏病学 心脏病学
- 血管生理学 血管生理学
- 诊断成像 诊断成像 诊断成像
背景情况:
- 传统的冠状动脉疾病 (CAD) 管理依赖于心上动脉评估,往往缺少微血管对缺血的贡献.
- 冠状动脉微血管功能障碍 (CMD) 是心肌缺血的一个重要因素,即使没有阻塞性心表疾病,但它经常被误诊.
- 目前的心脏导管实践缺乏对CMD的常规评估,限制了其临床整合.
研究的目的:
- 审查用于评估冠状动脉微血管功能障碍 (CMD) 的诊断工具和定量指标.
- 突出CMD评估对患者管理的临床实用性和影响,特别是对缺血和非阻塞性冠状动脉 (INOCA) 的治疗.
主要方法:
- 探索新兴的侵入性技术:热稀释指数,冠心内多普勒和功能冠心血管学.
- 对非侵入性模式的审查:心脏MRI,PET,胸前多普勒心声学和基于CT的输液成像.
- 专注于微血管阻力,冠状动脉流量储备和组织 perfusion 的定量指标.
主要成果:
- 侵入性和非侵入性方法提供了对微血管生理学和组织输液的定量见解.
- 这些先进的技术使CMD的综合评估成为可能,为以导管为基础的评估提供了替代方案.
- 这些工具的整合增强了INOCA患者的风险分层和个性化管理.
结论:
- 冠状动脉微血管功能障碍 (CMD) 在心肌缺血中起着关键作用,需要全面的诊断评估.
- 现在有一系列先进的侵入性和非侵入性工具可用于准确的CMD评估.
- 整合这些诊断方法可以改善患者管理和风险分层,特别是在INOCA患者中.
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