ROLUL INFLAMAȚIEI ȘI A TERAPIEI ANTIINFLAMATORII ÎN BCC NON-OBSTRUCTIVĂ
DOI:
https://doi.org/10.52692/1857-0011.2025.1-81.15Cuvinte cheie:
BCC non- obstructivă, angină microvasculară, INOCA, ANOCA, Colchicina, SGLT2Rezumat
O mare parte dintre pacienții supuși angiografiei coronariene din cauza anginei pectorale nu au artere coronare epicardice obstructive (ANOCA). La acești pacienți, prevalența ischemiei demonstrabile (INOCA) variază, în funcție de testul de stres efectuat, între 10% și 30%. Cercetările din ultimii ani s-au concentrat pe încercarea de a defini, clasifica și trata acești pacienți în funcție de endotipurile INOCA.Un rol important în apariția și dezvoltarea bolii coronariene cronice non-obstructive (BCC non-obstructivă) îl joacă inflamația și disfuncția endotelială, iar determinarea corelației dintre acestea și patologia în sine poate oferi o strategie de tratament țintit.Prezentul articol sintetizează datele disponibile din ultimii 10 ani din literatura de specialitate, identificate prin intermediul bazelor de date Google Scholar și PubMed, utilizând cuvinte-cheie precum: inflamația în BCC non-obstructivă și terapia antiinflamatorie în BCC non-obstructivă. Au fost incluse exclusiv sursele relevante din punct de vedere științific, care abordează aspecte privind importanța clinică, mecanismele fiziopatologice, metodele de evaluare și strategiile de management ale BCC non-obstructive, punând un accent particular pe rolul inflamației, al disfuncției endoteliale și al intervențiilor terapeutice cu caracter antiinflamator.
Referințe
Knuuti, J. et al., 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. European Heart Journal, 2020;41(3):407– 477.
Aribas, E. et al., Prevalence of microvascular angina among patients with stable symptoms in the absence of obstructive coronary artery disease: a systematic review. Cardiovascular Research, 2022;118(3):763– 771.
Vrints, C. et al., 2024 ESC guidelines for the management of chronic coronary syndromes: developed by the task force for the management of chronic coronary syndromes of the European Society of Cardiology (ESC) endorsed by the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal, 2024;45(36):3415–3537.
Jespersen, L. et al., Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events. European Heart Journal, 2012;33(6):734–744.
Marzilli, M. et al., Myocardial ischemia: from disease to syndrome. International Journal of Cardiology, 2020;314:32–35.
Lakshmanan, S. et al., Comparison of risk profiles of participants in the Women’s IschemiA TRial to Reduce events In non-ObstRuctive CAD (WARRIOR) trial, using Coronary Computed Tomography Angiography vs Invasive Coronary Angiography. Progress in Cardiovascular Diseases, 2024;84:90–93.
Luu, J. et al., Refractory angina in women with ischemia and no obstructive coronary artery disease—A report from the WISE-CVD study. American Heart Journal Plus: Cardiology Research and Practice, 2025;54:100547
Guo, Z. et al., Inflammation and coronary microvascular disease: relationship, mechanism and treatment. Frontiers in Cardiovascular Medicine, 2024;11:1280734.
Masi, S. et al., Assessment and pathophysiology of microvascular disease: recent progress and clinical implications. European Heart Journal, 2021;42(26):2590–2604.
Wang, X. & He, B., Endothelial dysfunction: molecular mechanisms and clinical implications. MedComm, 2024;5(8):e651.
Padro, T. et al., ESC Working Group on Coronary Pathophysiology and Microcirculation position paper on coronary microvascular dysfunction. Cardiovascular Research, 2020;116(4):741–755.
Zeng, Y. et al., MDM2-mediated ubiquitination of RXRβ contributes to mitochondrial damage and related inflammation. International Journal of Molecular Sciences, 2022;23(10):5766.
Hung, O.Y., Lee, S.K., Eshtehardi, P. & Samady, H., Novel biomarkers of coronary microvascular disease. Future Cardiology, 2016;12(4):497–509.
Rocco, E. et al., Advances and challenges in biomarkers use for coronary microvascular dysfunction. Journal of Clinical Medicine, 2022;11(7):2055.
Suhrs, H.E. et al., Inflammation, non-endothelial dependent coronary microvascular function and diastolic function. PLOS One, 2020;15(7):e0236035.
Recio-Mayoral, A. et al., Inflammation and microvascular dysfunction in cardiac syndrome X patients. JACC: Cardiovascular Imaging, 2013;6(6):660–667.
Schroder, J. et al., Pro-inflammatory biomarkers in women with non-obstructive angina pectoris. IJC Heart & Vasculature, 2019;24:100370.
Ong, P. et al., International standardization of diagnostic criteria for microvascular angina. International Journal of Cardiology, 2018;250:16–20.
Hosadurg, N. et al., Emerging pathway to a precision medicine approach for angina with nonobstructive coronary arteries in women. JACC: Advances, 2024;3(8):101074.
Hwang, D., Park, S.H. & Koo, B.K., Ischemia with nonobstructive coronary artery disease: concept, assessment, and management. JACC: Asia, 2023;3(2):169–184.
Deftereos, S.G. et al., Colchicine in cardiovascular disease: in-depth review. Circulation, 2022;145(1):61– 78.
Nidorf, S.M. et al., Low-dose colchicine for secondary prevention of cardiovascular disease. Journal of the American College of Cardiology, 2013;61(4);404– 410.
Nidorf, S.M. et al., Colchicine in patients with chronic coronary disease. New England Journal of Medicine, 2020;383(19):1838–1847.
Yu, Y. et al., Study on the mechanism of action of colchicine in the treatment of coronary artery disease. Frontiers in Pharmacology, 2023;14:1147360.
Jaiswal, V. et al., Short and long term efficacy of Colchicine for prevention of stroke and major adverse cardiovascular events: A meta-analysis with CHANCE 3, and CONVINCE randomized controlled trials. Stroke, 2025;56(1):A16–A16.
Jean-Claude Tardif & Kouz, S. Efficacy and safety of colchicine and spironolactone after myocardial infarction: the CLEAR-SYNERGY trial in perspective. European Heart Journal. Acute Cardiovascular Care, 2024;13(12):843–844.
Trube, J. et al., Colchicine therapy in cardiovascular medicine: a literature review. American Heart Journal Plus: Cardiology Research and Practice, 2025;52:100525.
Imazio, M. & Nidorf, M. Colchicine and the heart.
European Heart Journal, 2021;42(28):2745–2760.
Andreis, A. et al., Efficacy and safety of colchicine for the prevention of major cardiovascular and cerebrovascular events in patients with coronary artery disease: a systematic review and meta-analysis on 12,869 patients. European Journal of Preventive Cardiology, 2021;28(17):1916–1925.
Ikonomidis, I. et al., Differential effects of inhibition of interleukin 1 and 6 on myocardial, coronary and vascular function. Clinical Research in Cardiology, 2019;108:1093–1101.
Sagris, M. et al. Inflammation in coronary microvascular dysfunction. International Journal of Molecular Sciences, 2021;22(24):13471.
Ridker, P.M. et al. Antiinflammatory therapy with canakinumab for atherosclerotic disease. New England Journal of Medicine, 2017;377(12):1119– 1131.
Sardu, C. et al. SGLT2-inhibitors effects on the coronary fibrous cap thickness and MACEs in diabetic patients with inducible myocardial ischemia. Cardiovascular Diabetology, 2023;22(1):80.
Zhu, J. et al., Association of glucose-lowering medications with cardiovascular outcomes: an umbrella review and evidence map. The Lancet Diabetes & Endocrinology, 2020;8(3):192–205.
Pahud de Mortanges, A. et al., The role of SGLT2 inhibitors in atherosclerosis: a narrative mini-review. Frontiers in Pharmacology, 2021;12:751214.
Ghosh-Swaby, O.R. et al. Glucose-lowering drugs or strategies, atherosclerotic cardiovascular events, and heart failure in people with or at risk of type 2 diabetes: an updated systematic review and meta-analysis of randomised cardiovascular outcome trials. The Lancet Diabetes & Endocrinology, 2020;8(5):418–435.
Abouelnour, A. & Gori, T., Vasomotor dysfunction in patients with ischemia and non-obstructive coronary artery disease: current diagnostic and therapeutic strategies. Biomedicines, 2021;9(12):1774.
Ling, H. et al. Ranolazine for improving coronary microvascular function in patients with nonobstructive coronary artery disease: a systematic review and meta-analysis. Quantitative Imaging in Medicine and Surgery, 2024;14(2):1451.
Kamisah, Y. & Che Hassan, H.H. Role of Trimetazidine in ameliorating endothelial dysfunction: a review. Pharmaceuticals, 2024;17(4):464.
Rakhimov, K. & Gori, T. Non-pharmacological treatment of refractory angina and microvascular angina. Biomedicines, 2020;8(8):285.
Imran, T.F. et al., Efficacy of spinal cord stimulation as an adjunct therapy for chronic refractory angina. Current Cardiology Reports, 2017;19:111.
Descărcări
Publicat
Număr
Secțiune
##category.category##
Licență
Copyright (c) 2025 Buletinul Academiei de Științe a Moldovei. Științe medicale
Această lucrare este licențiată în temeiul Creative Commons Attribution 4.0 International License.
