Стенокардия без обструктивного поражения коронарных артерий (часть 1). Патофизиологические аспекты развития

С.П. Соловей

Республиканский научно-практический центр «Кардиология», г. Минск

Стенокардия является одним из наиболее частых симптомов ишемической болезни сердца (ИБС). Проведение коронароангиографического обследования у значительной части пациентов со стенокардией и признаками ишемии миокарда не обнаруживает обструктивных атеросклеротических изменений коронарных артерий (КА). Самостоятельными или дополнительными механизмами ишемии могут быть микрососудистая дисфункция и эпикардиальный коронарный вазоспазм. Клиническая форма ИБС, в основе которой лежит ишемия, вызванная дисфункцией коронарных сосудов в отсутствии обструктивных изменений, относительно недавно получила определение INOCA (Ischaemia with No Obstructive Coronary Artery Disease). Понятие INOCA объединяет две разновидности стенокардии – микрососудистую и вазоспастическую. Лежащие в основе INOCA коронарные вазомоторные расстройства имеют как различные патофизиологические механизмы, так и локализацию в самой сосудистой системе коронарного кровообращения. Клинически наиболее важными вазомоторными нарушениями являются эпикардиальный и микрососудистый вазоспазм, нарушение микрососудистой вазодилатации. В статье изложен краткий обзор механизмов регуляция коронарного кровотока в физиологических условиях и сосудистой дисфункции при необструктивном атеросклеротическом поражении.

ключевые слова: необструктивное поражение, микрососудистая дисфункция, эпикардиальный вазоспазм, микрососудистая стенокардия, вазоспастическая стенокардия

для цитирования: С.П. Соловей. Стенокардия без обструктивного поражения коронарных артерий (часть 1). Патофизиологические основы развития. Неотложная кардиология и кардиоваскулярные риски, 2021, Т. 5, № 2, С. 1274–.1283

Angina without obstructive lesion coronary arteries (part 1). Pathophysiological aspects of development

S.Р. Solovey

Angina pectoris is one of the most common symptoms of ischemic heart disease (IHD). Coronary angiography in a significant part of patients with angina pectoris and signs of myocardial ischemia does not reveal obstructive atherosclerotic changes in the coronary arteries. Independent or additional mechanisms of ischemia can be microvascular dysfunction and epicardial coronary vasospasm. The clinical form of ischemic heart disease, which is based on ischemia caused by dysfunction of the coronary vessels in the absence of obstructive changes, has recently received the definition of INOCA (Ischaemia with No Obstructive Coronary Artery Disease). The concept of INOCA comprises two types of angina pectoris – microvascular and vasospastic. The underlying INOCA coronary vasomotor disorders have both different pathophysiological mechanisms and localization in the vascular system of the coronary circulation itself. Clinically the most important vasomotor disorders are epicardial and microvascular vasospasm, impaired microvascular vasodilation. The article provides a brief overview of the mechanisms of regulation of coronary blood flow under physiological conditions and vascular dysfunction in non-obstructive atherosclerotic lesions.

keywords: non-obstructive lesion, microvascular dysfunction, epicardial vasospasm, microvascular angina, vasospastic angina

for references: S.Р. Solovey. Angina without obstructive lesion coronary arteries (part 1). Pathophysiological basis of development. Neotlozhnaya kardiologiya i kardiovaskulyarnye riski [Emergency cardiology and cardiovascular risks], 2021, vol. 5, no. 2, pp. 1274–1283

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