Angina, “Normal” Coronary Angiography, and Vascular Dysfunction Risk Assessment Strategies 英文参考文献.docVIP

Policy Forum Angina, “Normal” Coronary Angiography, and Vascular Dysfunction: Risk Assessment Strategies * Raffaele Bugiardini , Lina Badimon, Peter Collins, Raimund Erbel , Kim Fox, Christian Hamm, Fausto Pinto, Annika Rosengren, Christodoulos Stefanadis, Lars Wallentin, Frans Van de Werf C hest pain may be associated with coronary arteries that appear “normal.” Normal is de?ned its usefulness, because patients with chest pain and normal angiography often exhibit a disorder not only of the coronary microcirculation, but also of the entire coronary artery and peripheral circulation [6,7]. here as no visible disease or luminal irregularities (less than 50%) as judged visually at coronary angiography. Normal angiography in patients with chest pain is ?ve times more common in women than in men [1]. Among patients with chest pain and normal angiography, an unknown number are suffering from cardiac pain of ischemic origin. Uncertainty is often dif?cult to allay, for medical attendants as well as for patients, resulting in perpetuation of symptoms, dif?culties in management, and establishment of risk of subsequent coronary events [2]. In this article, we discuss how to stratify risk in patients with chest pain and a normal coronary angiogram. We based our article on a literature review, using the key words “angina with normal angiography,” “angina with normal coronary arteries,” “non-obstructive coronary disease,” or “chest pain of non-cardiac origin,” plus “[a]etiology,” “pathophysiology,” “diagnosis,” Mechanisms The idea that some forms of ischemic heart disease may be caused by abnormalities of the microcirculatory vessels is not new. This idea was proposed 16 years ago as a cause of angina pectoris [4]. Although the importance of microcirculation for the regulation of coronary blood ?ow has become clearer, pathophysiological explanations of the disease process are still poorly understood. Vascular dysfunction. Abnormality of both endothelium-dependent and independe