冠状动脉微血管功能障碍临床诊断策略新进展

Progress in practical considerations for diagnostic tests of coronary microvascular dysfunction

临床实践中无阻塞性冠状动脉(冠脉)病变的心绞痛患者并不少见,然而冠脉造影未发现固定阻塞性病变并不能代表整个冠脉树功能正常。冠脉血管功能性病变尤其是冠脉微血管功能障碍(CMD)在此类病例中占有很大比例。冠脉造影中通过侵入性手段检测冠脉微循环功能是目前CMD诊断的金标准。非侵入性检查手段如正电子发射型计算机断层显像(PET)、心脏核磁共振(CMR)等有希望逐渐成为替代检测手段。由于越来越多的研究证实CMD患者(尤其是女性患者)发生心血管事件风险显著增加,因此明确CMD诊断具有重要意义。此文对近年来CMD临床检测手段新进展进行综述,并据此提出临床诊断策略。

Angina without obstructive coronary artery disease is a common clinical finding,however,the absence of significant coronary stenosis on angiography does not necessarily imply a ＂ healthy＂ coronary tree.In such cases,functional disease especially the coronary microcirculation accounts for a large number of cases.Invasive coronary reactivity testing on coronary angiography is considered to be the ＂gold standard＂ for diagnosis of CMD.Noninvasive imaging techniques such as PET and cardiac magnetic resonance hold promise for detection of CMD in the future.Definitive diagnosis of coronary microcirculation dysfunction（CMD）is critical as recent evidence suggests that women with this condition are at increased risk of cardiovascular events in the future.Here we discuss the progress in practical considerations for diagnostic tests of coronary microvascular dysfunction and propose a diagnostic sequence of reasonable practical implementation.