References

emcardio

Неотложная кардиология и кардиоваскулярные риски

Emergency Cardiology and Cardiovascular Risks journal

2616-633X

Белорусский государственный медицинский университет

10.51922/2616-633X.2023.7.1.1742

emcardio-55

Research Article

Мастер-класс

Master-class

Стенокардия без обструктивного поражения коронарных артерий (Часть 3). Лечебная тактика на современном этапе

Angina without obstructive coronary artery disease (Part 3). Modern treatment strategies

Соловей

С. П.

Solovey

г. Минск

Minsk

Республиканский научно-практический центр «Кардиология»Scientific and Practical Centre “Cardiology”

2023

20062025

7117421757

2025

Соловей С.П.

Solovey S.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://emcardio.bsmu.by/jour/article/view/55

Основной причиной стенокардии у пациентов без обструктивного поражения коронарных артерий (КА) является вазомоторная дисфункция, включающая различные патофизиологические эндотипы: макро- или микрососудистый вазоспазм, сниженную микрососудистую вазодилатацию или повышенное сопротивление, а также их сочетания. Такие пациенты имеют не только персистирующие симптомы стенокардии, что приводит к частым госпитализациям и повторным диагностическим обследованиям с целью выявления обструктивной ишемической болезни сердца (ИБС), но и повышенный риск неблагоприятных сердечно-сосудистых событий. Стандартная антиангинальная терапия при этом оказывается менее эффективной, а разработка новых, специфических для данного варианта ИБС фармакологических средств все еще остается неудовлетворенной потребностью. В то же время показано, что соблюдение соответствующего конкретному эндотипу заболевания лечебного протокола улучшает контроль симптомов и качество жизни.Лечение пациентов включает мероприятия по модификации образа жизни с контролем кардиоваскулярных факторов риска и антиангинальную терапию, для таргетного назначения которой необходима точная, в большинстве случаев инвазивная, диагностика патофизиологического эндотипа. Важной составляющей терапии является немедикаментозное воздействие, особенно у пациентов с рефрактерной стенокардией. В статье рассмотрены различные, в том числе экспериментальные, варианты лечения и их обоснование у пациентов со стенокардией без обструктивного поражения КА.

The main cause of angina in patients without obstructive coronary artery (CA) disease is vasomotor dysfunction, including various pathophysiological endotypes: macro- or microvascular vasospasm, reduced microvascular vasodilation or increased resistance, as well as their combinations. Such patients not only have persistent angina symptoms, leading to frequent hospitalizations and repeated diagnostic tests for obstructive coronary heart disease (CHD), but also an increased risk of adverse cardiovascular events. In such cases, standard antianginal therapy turns out to be less effective, and the development of new pharmacological agents specific for this variant of CHD still remains an unsatisfied need. At the same time, it has been shown that compliance with the treatment protocol corresponding to a specific disease endotype improves symptom control and quality of life.Treatment of patients includes lifestyle modification measures with control of cardiovascular risk factors, and antianginal therapy, the targeting of which requires accurate, in most cases invasive, diagnosis of pathophysiological endotype. An important component of the treatment process is a non-drug effect, especially in patients with refractory angina pectoris. The article discusses various treatment options (including experimental) and their rationale in patients with angina pectoris without obstructive lesions of the СА.

необструктивное поражениемикрососудистая дисфункцияэпикардиальный вазоспазммикрососудистая стенокардиявазоспастическая стенокардия

non-obstructive lesionmicrovascular dysfunctionepicardial vasospasmmicrovascular anginavasospastic angina

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The authors declare that there are no conflicts of interest present.