在ANOCA患者中评估冠状动脉血管功能障碍的非侵入性和侵入性诊断方式
Isa Bijloo1, Janneke Woudstra1, Elif Aribas2
1Department of Cardiology, Amsterdam UMC Heart Center, Amsterdam, the Netherlands.
概括
非侵入性测试显示,在患有非阻塞性冠状动脉疾病 (ANOCA) 的胸痛患者中诊断冠状动脉功能障碍有前途. 然而,侵入性测试对于全面评估所有类型的功能障碍至关重要.
科学领域:
- 心脏病学 心脏病学
- 诊断成像 诊断成像 诊断成像
- 血管医学 血管医学
背景情况:
- 带有非阻塞性冠状动脉疾病 (ANOCA) 的心痛需要准确诊断冠状动脉功能障碍.
- 冠状动脉功能障碍包括血管,内皮功能障碍和微血管功能障碍 (冠状动脉流量储备减少[CFR]和/或微血管抵抗增加[MR]).
- 侵入性冠状动脉功能测试 (ICFT) 是黄金标准,但具有侵入性.
研究的目的:
- 对ANOCA患者冠状动脉功能障碍的侵入性和非侵入性诊断方式进行审查和比较.
- 评估非侵入性方法与侵入性测试的等价性.
- 确定目前对非侵入性诊断的局限性和未来的研究需求.
主要方法:
- 对冠状动脉功能障碍的侵入性和非侵入性诊断技术的现有文献的审查.
- 分析用于评估冠状动脉,内皮功能障碍,CFR和MR的方法.
- 与ICFT相比,非侵入性方法 (PET,TTDE,CMR) 的诊断能力的比较.
主要成果:
- 只有冠状动脉流量储备 (CFR) 才能使用PET,TTDE和潜在的CMR可靠地进行非侵入性测量.
- 诊断冠状动脉,内皮功能障碍或微血管抵抗 (MR) 的非侵入性技术很少.
- 目前的非侵入性技术的附加值是有限的,因为多个冠状动脉功能障碍内型的频繁同时发生.
结论:
- 目前,非侵入性方法不足以在ANOCA患者中全面诊断所有冠状动脉功能障碍内型.
- ICFT仍然是唯一能够评估冠状动脉功能障碍的所有组成部分的方法.
- 需要进一步的研究来开发和验证在ANOCA中诊断冠状动脉功能障碍的所有方面的非侵入性方法.
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