Abstract
Zusammenfassung. Die koronare Mikrozirkulationsstörung weist insbesondere bei Frauen ab dem fünfzigsten Lebensjahr eine hohe Prävalenz auf und führt sowohl zu pektanginösen Symptomen wie auch zu einer erhöhten Rate kardiovaskulärer Ereignisse. Durch die auch heutzutage noch bestehende Unterdiagnostizierung haben viele Patientinnen und Patienten einen langen Leidensweg hinter sich. Mit einer invasiven Koronarangiografie, die sowohl eine Messung der koronaren Flussreserve wie auch eine Acetylcholin-Provokationstestung beinhaltet, kann die Diagnose einer koronaren Mikrozirkulationsstörung gestellt werden. Dies ist einerseits für das Wohl der Patientinnen und Patienten wichtig, ermöglicht andererseits aber auch eine gezielte Therapie. Diese besteht aus Lebensstilveränderungen, einer optimalen Kontrolle kardiovaskulärer Risikofaktoren sowie spezifischen anti-anginösen Medikamenten. Die aktuelle Forschung versucht, pathophysiologische Mechanismen besser zu verstehen und verbesserte oder alternative diagnostische Verfahren und neue Therapiekonzepte zu entwickeln.
Abstract. Microvascular angina is a common manifestation of coronary microvascular dysfunction, particulary prevalent in post-menopausal women above the age of 50 and associated with impaired quality of life and poor clinical outcomes. However, microvascular angina remains largely undetected given the underuse of diagnostic tools for the assessment of coronary microvascular function. As a consequence, many of these patients suffering from coronary microvascular dysfunction fail to receive the appropriate medical treatment and remain in the long term symptomatic. Invasive coronary catheterization with measurement of coronary flow reserve and intracoronary acetylcholine provocation testing allows for the assessment of coronary microvascular dysfunction, and a therapy targeting specific physiological pathways can be implemented. A targeted therapy includes lifestyle modifications, secondary prevention measures, and anti-anginal medication. Ongoing clinical research in the field is expected to deliver novel diagnostic and therapeutic concepts for an improved management of patients with coronary microvascular disease.
Résumé. Le trouble de la microcirculation coronaire présente une prévalence élevée, en particulier chez les femmes de plus de 50 ans, et entraîne des symptômes pectangineux ainsi qu’un taux accru d’événements cardiovasculaires. Actuellement sous-diagnostiqué, ce trouble entraîne des symptômes pendant longtemps. Une coronarographie qui comprend une mesure de la réserve du flux coronaire ainsi qu’un test de provocation à l’acétylcholine permet d’examiner la fonction des artères coronaires et de poser le diagnostic. Ce n’est seulement important pour le bien-être des patients, mais cela permet également de mettre en place une thérapie ciblée, consistant en des modifications du mode de vie, un contrôle optimal des facteurs de risque cardiovasculaire et des médicaments anti-angineux spécifiques. La recherche actuelle tente de mieux comprendre les mécanismes physiopathologiques et de développer des méthodes de diagnostic améliorées ou alternatives ainsi que de nouveaux concepts thérapeutiques.
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. https://clinicaltrials.gov/ct2/show/NCT05294887; letzter Zugriff: 23.08.2022.
