Концепция ANOCA/INOCA: современные клинические данные и обновлённые подходы
DOI:
https://doi.org/10.52692/1857-0011.2025.1-81.10Ключевые слова:
ANOCA/INOCA, сосудистая дисфункция, эндотипыАннотация
Стенокардия и ишемия без обструкции коронарных артерий (ANOCA/INOCA) являются проявлениями не обструктивной формы хронической коронарной болезни (ХКБ) и характеризуются наличием стенокардических симптомов или признаков миокардиальной ишемии при отсутствии обструктивных поражений эпикардиальных коронарных артерий. Обе клинические сущности имеют общие механизмы сосудистой дисфункции, называемые эндотипами: эндотелиальная дисфункция, нарушенная вазодилатация, эпикардиальный вазоспазм, микрососудистый вазоспазм, а также их сочетания. Эти механизмы обладают клинической значимостью, выражающейсяврефрактернойстенокардии,повышенномрискесерьёзныхсердечно-сосудистыхсобытий(MACE) и значительном ухудшении качества жизни. Обновлённые рекомендации Европейского общества кардиологов (ESC) 2024 года по ведению хронических коронарных синдромов (ХКС) уделяют повышенное внимание ANOCA/INOCA, предлагая диагностические и терапевтические подходы. С целью персонализированного подхода, основанного на эндотипах и достоверных доказательствах, возникает настоятельная необходимость в дополнительных клинических исследованиях, способных определить эффективные стратегии диагностики и новые методы лечения пациентов с синдромом ANOCA/INOCA.
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