Стенокардия без обструктивного поражения коронарных артерий (Часть 2). Методы диагностики в клинической практике

С.П. Соловей

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

Коронарные вазомоторные нарушения являются частой причиной стенокардии без обструктивного поражения коронарных артерий (КА). За последнее десятилетие различные неинвазивные и инвазивные методы диагностики позволили всесторонне оценить коронарную вазомоторную функцию и определить эндотипы эпикардиальной и микрососудистой дисфункции, что является важным для стратификации кардиоваскулярного риска и индивидуализации лечения пациента. Основой диагностики сложного взаимодействия вазодилатации и вазоконстрикции различных отделов коронарного русла остается комплексное внутрикоронарное функциональное тестирование, рекомендуемое при сохранении симптомов стенокардии на фоне ангиографически неизмененных или умеренно стенозированных, не ограничивающих кровоток, КА. Установленными параметрами, характеризующими адекватную вазодилатацию, являются резерв коронарного кровотока и микрососудистое сопротивление. Повышенный сосудосуживающий потенциал диагностируется путем внутрикоронарного провокационного теста с ацетилхолином, что позволяет верифицировать эпикардиальный и/или микрососудистый вазоспазм. В статье рассматриваются стандартизированные критерии, неинвазивные визуализирующие методы и современные алгоритмы инвазивного обследования, используемые для постановки диагноза микрососудистой и вазоспастической стенокардии.

ключевые слова: необструктивное поражение, микрососудистая дисфункция, эпикардиальный вазоспазм, микрососудистая стенокардия, вазоспастическая стенокардия, неинвазивная диагностика, внутрикоронарное функциональное тестирование.

для цитирования: С.П. Соловей. Стенокардия без обструктивного поражения коронарных артерий (часть 2). Методы диагностики в клинической практике. Неотложная кардиология и кардиоваскулярные риски, 2022, Т. 6, № 1, С. 1424–1441.

Angina pectoris without obstructive coronary lesion (Part 2). Diagnosic methods in clinical practice

S. Solovey

Coronary vasomotor disorders are a common cause of angina pectoris without obstructive lesion of the coronary arteries (CA). Over the past decade, various non-invasive and invasive diagnostic methods have made it possible to comprehensively assess coronary vasomotor function and determine the endotypes of epicardial and microvascular dysfunction, which is important for stratification of cardiovascular risk and individualization of patient treatment. The basis for the diagnosis of the complex interaction of vasodilation and vasoconstriction of various parts of the coronary bed is a comprehensive intracoronary functional testing, which is recommended if the angina symptoms are persisting against the background of angiographically unchanged or moderately stenosed, blood flow non-limiting coronary arteries. The established parameters characterizing adequate vasodilation are coronary blood flow reserve and microvascular resistance. Increased vasoconstriction potential is diagnosed by intracoronary provocation test with acetylcholine, which allows verification of epicardial and/or microvascular vasospasm. The article discusses standardized criteria, non-invasive imaging methodsand modern invasive examination algorithms used in the diagnosis of microvascular and vasospastic angina.

keywords: non-obstructive lesion, microvascular dysfunction, epicardial vasospasm, microvascular angina, vasospastic angina, non-invasive diagnostics, intracoronary functional testing.

for references: Angina pectoris without obstructive coronary lesion (part 2). Diagnosic methods in clinical practice. Neotlozhnaya kardiologiya i kardiovaskulyarnye riski [Emergency cardiology and cardiovascular risks], 2022, vol. 6, no. 1, pp. 1424–1441.

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