变异型心绞痛腔内影像学特征及其临床意义
李健楠,颜红兵
摘要(Abstract):
<正>变异型心绞痛是由冠状动脉短暂、反复痉挛引起的,心电图相应导联表现为ST段抬高的特殊类型心绞痛~([1])。变异型心绞痛患者急性心肌梗死发生率高达17%~([2])。大多数变异型心绞痛患者冠状动脉造影提示正常,对于其处理临床上常常束手无策。由于目前对于冠状动脉痉挛的结构、成因和机制认识不足,临床上无法进行风险分层,制定相应的治疗策略。
关键词(KeyWords): 变异型心绞痛;冠状动脉痉挛;血管内超声;光学相干断层扫描
基金项目(Foundation): 中国医学科学院医学与健康科技创新工程基金(2016-I2M-1-009)
作者(Author): 李健楠,颜红兵
参考文献(References):
- [1]Stern S,Bayes de Luna A.Coronary artery spasm:a 2009update.Circulation,2009,119(18):2531-2534.
- [2]Takagi Y,Yasuda S,Tsunoda R,et al.Clinical characteristics and long-term prognosis of vasospastic angina patients who survived out-of-hospital cardiac arrest:multicenter registry study of the Japanese Coronary Spasm Association.Circ Arrhythm Electrophysiol,2011,4(3):295-302.
- [3]Hong MK,Park SW,Lee CW,et al.Intravascular ultrasound findings of negative arterial remodeling at sites of focal coronary spasm in patients with vasospastic angina.Am Heart J,2000,140(3):395-401.
- [4]Saito S,Yamagishi M,Takayama T,et al.Plaque morphology at coronary sites with focal spasm in variant angina:Study using intravascular ultrasound.Circ J,2003,67(12):1041-1045.
- [5]Tanaka A,Shimada K,Tearney GJ,et al.Conformational change in coronary artery structure assessed by optical coherence tomography in patients with vasospastic angina.J Am Coll Cardiol,2011,58(15):1608–1613.
- [6]Miyao Y,Kugiyama K,Kawano H,et al.Diffuse intimal thickening of coronary arteries in patients with coronary spastic angina.J Am Coll Cardiol,2000,36(2):432-437。
- [7]Hong YJ,Jeong MH,Choi YH,et al.Plaque components at coronary sites with focal spasm in patients with variant angina:virtual histology-intravascular ultrasound analysis.Int J Cardiol,2010,144(3):367–372.
- [8]Wijns W,Shite J,Jones MR,et al.Optical coherence tomography imaging during percutaneous coronary intervention impacts physician decision-making:ILUMIEN I study.Eur Heart J,2015,36(47):3346-3355.
- [9]Shin ES,Ann SH,Singh GB,et al.OCT–defined morphological characteristics of coronary artery spasm sites in vasospastic angina.JACC Cardiovasc Imaging,2015,8(9):1059–1067.
- [10]Shin ES,Her AY,Ann SH,et al.Thrombus and plaque erosion characterized by optical coherence tomography in Ppatients with vasospastic angina.Rev Esp Cardiol(Engl Ed),2017,70(6):459-466.
- [11]Papaspyridonos M,Smith A,Burnand KG,et al.Novel candidate genes in unstable areas of human atherosclerotic plaques.Arterioscler Thromb Vasc Biol,2006,26(8):1837-1844.
- [12]Park HC,Shin JH,Jeong WK,et al.Comparison of morphologic findings obtained by optical coherence tomography in acute coronary syndrome caused by vasospasm and chronic stable variant angina.Int J Cardiovasc Imaging,2015,31(2):229–237.
- [13]Amsterdam EA,Wenger NK,Brindis RG,et al.2014 AHA/ACC guideline for the management of patients with non–ST-elevation acute coronary syndromes:a report of the American College of Cardiology/American Heart Association task force on practice guidelines.J Am Coll Cardiol,2014,64(24):e139–e228.
- [14]向定成,曾定尹,霍勇.冠状动脉痉挛综合征诊断与治疗中国专家共识.中国介入心脏病学杂志,2015,23(4):181-186.