References

emcardio

Неотложная кардиология и кардиоваскулярные риски

Emergency Cardiology and Cardiovascular Risks journal

2616-633X

Белорусский государственный медицинский университет

10.51922/2616-633X.2022.6.1.1424

emcardio-98

Research Article

Мастер-класс

Master-class

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

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

Соловей

С. П.

Solovey

г. Минск

Minsk

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

2022

27062025

6114241441

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/98

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 внут рикоронарного 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.

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 methods and modern invasive examination algorithms used in the diagnosis of microvascular and vasospastic angina.

необструктивное поражениемикрососудистая дисфункцияэпикардиальный вазоспазммикрососудистая стенокардиявазоспастическая стенокардиянеинвазивная диагностикавнутрикоронарное функциональное тестирование

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