Tom 19, Nr 3-4 (2024)
Inne materiały uzgodnione z Redakcją
Opublikowany online: 2025-03-27
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Funkcjonalna diagnostyka mikrokrążenia w przewlekłym zespole wieńcowym bez istotnych zmian w tętnicach nasierdziowych
Kardiol Inwazyjna 2024;19(3-4):56-65.
Streszczenie
U ponad połowy pacjentów z przewlekłą dusznicą bolesną poddawanych planowej koronarografii stwierdza się brak istotnych zwężeń w tętnicach wieńcowych (ANOCA, angina with non-obstructive coronary arteries), natomiast u około ¼ z nich stwierdza się cechy niedokrwienia (INOCA, ischemia with non-obstructive coronary arteries). Głównymi przyczynami ANOCA/INOCA są dysfunkcja śródbłonka, upośledzona funkcja rozkurczowa, postać skurczowa ANOCA/INOCA lub ich kombinacje. Obecnie jedyną metodą diagnostyczną pozwalającą na zróżnicowanie endotypu ANOCA/INOCA jest inwazyjne czynnościowe badanie tętnic wieńcowych (ICFT, invasive coronary functional testing). ICFT to badanie, podczas którego wykonuje się ocenę rezerwy wieńcowej (CFR, coronary flow reserve), oporu naczyniowego (MVR, microvascular resistance) w spoczynku, a jeśli konieczne to także po dowieńcowym podaniu acetylocholiny w rosnącej dawce i na końcu adenozyny. Prawidłowe rozpoznanie i sklasyfikowanie endotypu ANOCA/INOCA jest kluczowe dla wprowadzenia dedykowanej terapii. W niniejszej pracy przedstawiono diagnostykę oraz postępowanie w przypadku podejrzenia ANOCA/INOCA ze szczególnym uwzględnieniem diagnostyki inwazyjnej tych zespołów.
Słowa kluczowe: ANOCAINOCAmikrokrążenieinwazyjne czynnościowe badanie tętnic wieńcowych
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