Pregledni rad

https://doi.org/10.20471/acc.2018.57.03.17

Nonobstructive Coronary Artery Disease – Clinical Relevance, Diagnosis, Management and Proposal of New Pathophysiological Classification

Zorin Makarović ; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; Department of Cardiology, Osijek University Hospital Centre, Osijek, Croatia
Sandra Makarović ; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; Department of Cardiology, Osijek University Hospital Centre, Osijek, Croatia
Ines Bilić-Ćurčić ; Department of Pharmacology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
Ivan Mihaljević ; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; Department of Nuclear Medicine and Radiation Protection, Osijek University Hospital Centre, Osijek, Croatia
Dražen Mlinarević ; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; Department of Cardiology, Osijek University Hospital Centre, Osijek, Croatia

Sažetak

New data gathered from large clinical trials indicate that nonobstructive coronary artery disease (non-CAD) is a clinical entity that should not be ignored. It is estimated that 50% of female population undergoing coronarography are diagnosed with non-CAD. There is also an increase in the prevalence of non-CAD in both genders, which is probably due to gradual expanding of clinical indications for angiography in patients with angina. Furthermore, considering the increased mortality risk established recently, a prognosis of non-CAD is not benign as previously thought. However, the concept and definition of non-CAD remains elusive causing difficulties in diagnosis and treatment. One of the major shortcomings is the exclusion-based diagnosis of non-CAD. Furthermore, treatment of non-CAD still presents a great challenge and optimal therapy is yet to be determined. There are two major hypotheses explaining the pathophysiological mechanisms of non-CAD, i.e. ischemic hypothesis based on abnormal microvascular dysfunction and non-ischemic one based on altered pain perception. This review encompasses a broader spectrum of pathophysiological mechanisms of non-CAD, and proposes a new way of classification based on the major disorder involved: type I (ischemic mechanisms) and type II (non-ischemic mechanisms), depending on which mechanism predominates. Hopefully, this would provide new insights in the understanding of this disorder, thus leading to accurate and early diagnosis and successful treatment, especially considering the increased mortality risk in these patients.

Ključne riječi

Coronary artery disease; Classification; Diagnosis; Angiography

Hrčak ID:

216162

URI

https://hrcak.srce.hr/216162

Datum izdavanja:

1.9.2018.

Podaci na drugim jezicima: hrvatski

Posjeta: 3.377 *