更新于：2024-05-01

Microvascular Angina

微血管心绞痛

更新于：2024-05-01

基本信息

别名

Angina Pectoris with Normal Coronary Arteriogram、Angina Syndrome X、Angina Syndrome Xs

+ [37]

简介

ANGINA PECTORIS or angina-like chest pain with a normal coronary arteriogram and positive EXERCISE TEST. The cause of the syndrome is unknown. While its recognition is of clinical importance, its prognosis is excellent. (Braunwald, Heart Disease, 4th ed, p1346; Jablonski Dictionary of Syndromes & Eponymic Diseases, 2d ed). It is different from METABOLIC SYNDROME X, a syndrome characterized by INSULIN RESISTANCE and HYPERINSULINEMIA, that has increased risk for cardiovascular disease.

关联

项与微血管心绞痛相关的药物

AB-3001

靶点-

作用机制-

在研机构

Abeille Pharmaceuticals, Inc.

原研机构

Abeille Pharmaceuticals, Inc.

在研适应症

微血管心绞痛

非在研适应症-

最高研发阶段临床前

首次获批国家/地区-

首次获批日期1800-01-20

SAR-407899

靶点

ROCK

作用机制

ρ-相关激酶抑制剂

在研机构-

原研机构

Sanofi-Aventis U.S. LLC

在研适应症-

非在研适应症

稳定型心绞痛 [+11]

最高研发阶段终止

首次获批国家/地区-

首次获批日期1800-01-20

TZP-301

靶点

ghrelin

作用机制

ghrelin拮抗剂

在研机构-

原研机构

Tranzyme Pharma, Inc.

在研适应症-

非在研适应症

微血管心绞痛 [+1]

最高研发阶段无进展

首次获批国家/地区-

首次获批日期1800-01-20

171

项与微血管心绞痛相关的临床试验

NCT03184155 / Withdrawn早期临床1期IIT

Prevention of Coronary Microvascular Dysfunction Post-PCI by Intracoronary Nicardipine

This is a single-center double blind, placebo controlled study of patients undergoing a cardiac catheterization where the need for a percutaneous coronary intervention (PCI) is anticipated or will be determined during the early diagnostic phase. The study will assess the use of intracoronary nicardipine vs. sterile saline injection in reducing the index measurement of microcirculatory resistance (IMR). Fifty consecutive patients presenting to the Thomas Jefferson University (TJUH) Cardiac Catheterization lab will be randomized in a 1:1 fashion to receive either intracoronary nicardipine or sterile saline injection prior to PCI. IMR values will be assessed pre and post procedure. Data on clinical outcomes and adverse events will be collected by phone at 30 days and 1 year following the procedure.

开始日期2025-12-01

申办/合作机构

Thomas Jefferson University

NCT05756088 / SuspendedN/AIIT

The DEPICT Prospective Study: Determining the Association of Microvascular Disease as Assessed by PET and Graft Injury as Assessed by Donor Derived Cell Free DNA Post Transplantation

The goal of this research study is to understand if a blood test in people who have had heart transplants can detect and predict the following:
Blockages in the small blood vessels of the heart.
Whether small blockages can turn into more severe blockages in the future.
Participants will undergo blood draws once every 3 months in the first year of the study (4 blood draws total, taking 15 minutes each) and their medical records will be reviewed for 3 years after the date they are enrolled in the study.

开始日期2024-11-01

申办/合作机构

Yale University

[+1]

NCT05793567 / Not yet recruitingN/A

Assessment of Microcirculatory Function in Type 2 Myocardial Infarction

The purpose of this research is to find out if patients with Type 2 Myocardial Infarction (T2MI) without significant epicardial coronary artery disease (CAD) have a greater chance of having coronary microvascular disease (CMD).

开始日期2024-11-01

申办/合作机构

Mayo Clinic

100 项与微血管心绞痛相关的临床结果

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100 项与微血管心绞痛相关的转化医学

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0 项与微血管心绞痛相关的专利（医药）

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2,120

项与微血管心绞痛相关的文献（医药）

2024-02-20·Circulation. Cardiovascular interventions

Angiography-Derived Index of Microcirculatory Resistance to Define the Risk of Early Discharge in STEMI.

Article

作者: Roberto Scarsini ; Rafail A Kotronias ; Francesco Della Mora ; Leonardo Portolan ; Stefano Andreaggi ; Stefano Benenati ; Federico Marin ; Sara Sgreva ; Alberto Comuzzi ; Caterina Butturini ; Gabriele Pesarini ; Domenico Tavella ; Keith M Channon ; Hector M Garcia Garcia ; Flavio Ribichini ; Adrian P Banning ; Giovanni Luigi De Maria

BACKGROUND:

Patients with ST-segment-elevation myocardial infarction but no coronary microvascular injury are at low risk of early cardiovascular complications (ECC). We aim to assess whether nonhyperemic angiography-derived index of microcirculatory resistance (NH-IMR_angio) could be a user-friendly tool to identify patients at low risk of ECC, potentially candidates for expedited care pathway and early hospital discharge.

METHODS:

Retrospective analysis of 2 independent, international, prospective, observational cohorts included 568 patients with ST-segment-elevation myocardial infarction. NH-IMR_angio was calculated based on standard coronary angiographic views with 3-dimensional-modeling and computational analysis of the coronary flow.

RESULTS:

Overall, ECC (a composite of cardiovascular death, cardiogenic shock, acute heart failure, life-threatening arrhythmias, resuscitated cardiac arrest, left ventricular thrombus, post-ST-segment-elevation myocardial infarction mechanical complications, and rehospitalization for acute heart failure or acute myocardial infarction at 30 days follow-up), occurred in 54 (9.3%) patients. NH-IMR_angio was significantly correlated with pressure/thermodilution-based index of microcirculatory resistance (r=0.607; P<0.0001) and demonstrated good accuracy in predicting ECC (area under the curve, 0.766 [95% CI, 0.706-0.827]; P<0.0001). Importantly, ECC occurred more frequently in patients with NH-IMR_angio ≥40 units (18.1% versus 1.4%; P<0.0001). At multivariable analysis, NH-IMR_angio provided incremental prognostic value to conventional clinical, angiographic, and echocardiographic features (adjusted-odds ratio, 14.861 [95% CI, 5.177-42.661]; P<0.0001). NH-IMR_angio<40 units showed an excellent negative predictive value (98.6%) in ruling out ECC. Discharging patients with NH-IMR_angio<40 units at 48 hours after admission would reduce the total in-hospital stay by 943 days (median 2 [1-4] days per patient).

CONCLUSIONS:

NH-IMR_angio is a valuable risk-stratification tool in patients with ST-segment-elevation myocardial infarction. NH-IMR_angio guided strategies to early discharge may contribute to safely shorten hospital stay, optimizing resources utilization.

2024-02-20·Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology

Feasibility of Myocardial Blood Flow Quantification to Detect Flow-limited Coronary Artery Disease with A One-day Rest/Stress Continuous Rapid Imaging Protocol on Cardiac-dedicated CZT SPECT.

Article

作者: Jiao Wang ; Yue Chen ; Hongxin Chu ; Zekun Pang ; Bailing Hsu ; Jianming Li

OBJECTIVE:

It is clinically needed to explore a more efficient imaging protocol for SPECT myocardial blood flow (MBF) quantitation derived from CZT SPECT camera towards the routine clinical utilization.

METHODS:

One-hundred and twenty patients with matched clinical characteristics and angiographic findings who completed one-day rest/stress SPECT imaging with either the intermittently sequential imaging (ISI) protocol (two dynamic and two ECG-gated scans) or the continuous rapid imaging (CRI) protocol (two dynamic/ECG-gated scans) were included. MBF quantitation adopted residual activity correction (RAC) to correct for rest residual activity (RRA) in the stress dynamic SPECT scan for the detection of flow-limited coronary artery disease.

RESULTS:

The CRI protocol reduced about 6.2 times shorter than the ISI protocol (25.5 min vs 157.6 min), but slightly higher RRA (26.7%±3.6% vs 22.3%±4.9%). With RAC, both protocols demonstrated close stress MBF (2.18±1.13 vs 2.05±1.10, p>0.05) and myocardial flow reserve (MFR) (2.42±1.05 vs 2.48±1.11, p>0.05) to deliver a comparable diagnostic performance (sensitivity= 82.1%-92.3%, specificity=81.2%-91.2%). Myocardial perfusion and left ventricular function overall showed no significant difference (all p>0.26).

CONCLUSION:

One-day rest/stress SPECT with the CRI protocol and rest RAC is feasible to warrant the diagnostic performance of MBF quantitation with shortened examination time and enhanced patient comfort. Further evaluation on the impact of extracardiac activity to regional MBF and perfusion pattern is required. Additional evaluation is needed in a patient population that is typical of those referred for SPECT MPI, including those with known or suspected coronary microvascular disease.

2024-02-13·International journal of cardiology

"The INOCA-IT: Rationale and design of a multicenter registry investigating ischemia in patients with non-obstructive coronary artery (INOCA) disease in Italy".

Article

作者: Giulia Ghizzoni ; Antonio Maria Leone ; Luigi di Serafino ; Domenico Galante ; Giovanni Esposito ; Matteo Montorfano ; Alaide Chieffo

BACKGROUND:

Ischemia with non-obstructive coronary artery (INOCA) disease is being progressively acknowledged as one of the pathophysiological mechanisms of chronic coronary syndrome (CCS) in an increasingly wide range of clinical pictures. Although the research has already begun to move towards a defined diagnostic pathway and a specific medical therapy for this disease, at present it remains a clinical challenge, especially if not thoroughly investigated.

METHODS AND RESULTS:

The INOCA IT Multicenter Registry RF-2019-12369486 is a prospective, multicentric, non-randomized, single-arm, open label clinical study which aims to evaluate the efficacy of a stratified diagnostic and therapeutic approach on adverse events prevention and symptom relief in Italian patients with INOCA disease. The study population includes patients with a clinical presentation of CCS for angina and/or positive stress test for myocardial ischemia and evidence of non-obstructive coronary artery disease (CAD) at coronary angiography. In these patients a complete invasive coronary physiology assessment is performed with the guidewire-based measurement of coronary flow reserve (CFR) and index of microvascular resistance (IMR), followed by acetylcholine (ACh) spasm provocation test. On the basis of the results of coronary function testing, patients are stratified into different INOCA endotypes (coronary microvascular disease, vasospastic angina, microvascular spasm, non-cardiac chest pain) and given a tailored medical therapy in accordance with the latest scientific evidence. At one year follow-up the impact of such a target therapy on angina class and quality of life, as well as on cardiovascular adverse events (hospitalization and coronary revascularization) is evaluated.

CONCLUSIONS:

The INOCA-IT Multicenter Registry will inform clinicians on sex-specific prevalence of INOCA in Italy and will show the impact of a stratified diagnostic and therapeutic approach on symptoms burden and prognosis of INOCA patients.

项与微血管心绞痛相关的新闻（医药）

2024-03-22

·米内网

【关注】循证充分、疗效确切，复方丹参滴丸或将开启CMVD管理新篇章

精彩内容经皮冠状动脉介入治疗（PCI）已成为冠心病患者最重要的血运重建手段。然而，很多患者行PCI后尽管支架通畅，但是仍有胸闷、心绞痛等症状，其发生率高达50％，这一现象困惑着心血管医师数十年。近年来，随着循证医学和介入及影像技术等的快速发展，人们才逐渐认识到冠状动脉微血管疾病（CMVD）也是造成心肌缺血的重要原因，致使患者预后不良，故需引起重视，并加强对其治疗管理。CMVD危害严重，亟需有效管理CMVD是指在多种致病因素的作用下，冠状前小动脉和小动脉的结构和（或）功能异常所致的劳力性心绞痛或存在心肌缺血客观证据的临床综合征[1]。目前临床上CMVD患者数目庞大，研究显示，在具有心肌缺血症状，但冠状动脉造影显示非阻塞性病变的患者中，CMVD发生率高达45%-60%[2]。CMVD不仅在临床广泛存在，而且还可能增加患者远期不良心血管事件风险，导致主要心血管事件及全因死亡率升高。在2023年美国心脏病学会科学年会(ACC 2023)上，一项Meta分析，纳入了22项符合条件的研究，包括10456例微循环功能障碍的冠心病患者，研究发现，微循环功能障碍与临床预后受损相关，微循环功能障碍患者主要心血管不良事件(MACE)风险升高111% (RR：2.11；95%CI 1.81-2.46；P<0.00001)；全因死亡率风险升高92% (RR 1.92；95%CI 1.61-2.30；P<0.00001)[3]。因此，CMVD的检出和治疗具有十分重要的临床意义。任重道远，CMVD诊治面临巨大挑战CMVD诊断和治疗都面临巨大挑战。诊断方面，微血管病变的诊断依赖于患者有心肌缺血相关的症状，但CMVD的自然病程往往具有相对较长的无症状期，因此早期诊断比较困难。此外，微血管病变的诊断还需要心肌缺血的客观依据，影像学检查，包括冠状动脉造影和冠状动脉CTA等技术已经普及，但评价微血管功能学的检测指标，例如冠状动脉血流储备或冠状动脉微血管阻力指数却远远没有得到普及。故诊断微循环病变并不容易，目前临床并没有辅助诊断CMVD的“金标准”，医务工作者需综合患者的临床表现和辅助检查结果，才能够作出初步诊断。在治疗方面也存在挑战，多种针对冠心病的防治措施，包括危险因素的控制，抗缺血的药物等，对微血管病变也是有效的。但是微血管病变患者心肌缺血的原因相对比较多，一些能有效扩张心外膜冠状动脉的药物对微血管没有明显的扩张作用，因此疗效有限，要针对微血管病变的原因采取相应的治疗。临床指南的制订有赖于高质量的循证证据，但目前，还缺乏针对微血管病变治疗的大规模随机对照临床研究的证据，故CMVD的治疗迄今为止一直是经验性的[4]。复方丹参滴丸优势明显，为CMVD治疗提供新选择随着中医药的发展，中医药在临床上的应用也得到进一步扩展，一些中成药同样具有治疗CMVD的效果，如复方丹参滴丸。基础研究显示，复方丹参滴丸具有改善CMVD多重机制，能够通过抗炎、改善内皮功能、改善微栓塞及心肌纤维化，有效缓解微循环障碍。临床实践证明，在常规西药治疗基础上加用复方丹参滴丸后会很大程度上缓解患者的心绞痛症状，有助于改善患者的预后。一项探讨复方丹参滴丸治疗微血管病变临床疗效的研究，纳入100例微血管病变患者, 对照组患者采用阿司匹林治疗, 观察组患者在对照组基础上采用复方丹参滴丸治疗，研究发现，复方丹参滴丸能够有效减少内皮素含量, 改善内皮依赖性舒张功能，治疗微血管病变的临床疗效显著[5]。另一项探究复方丹参滴丸对心脏X综合征(CSX)患者心肌缺血和血管内皮功能影响的研究，纳入80例CSX患者，对照组采用扩张冠脉、抗血小板聚集等常规治疗，观察组在常规治疗基础上加服复方丹参滴丸。研究发现，复方丹参滴丸能显著减轻患者心肌缺血，改善血管内皮功能，对患者心绞痛症状有很好的治疗效果[6]。因其充分的循证证据，复方丹参滴丸获得多部指南共识推荐，如《冠状动脉微血管疾病中西医结合诊疗专家共识》[7]建议，微血管性心绞痛辨证属气滞血瘀证患者可在西医常规治疗的基础上应用复方丹参滴丸(强推荐)；复方丹参滴丸联合常规西药可用于改善PCI术后冠状动脉无复流患者的冠状动脉血流(强推荐)。《冠状动脉微血管病中西医结合诊疗指南》[8]也提出，对于气滞血瘀型微血管性心绞痛患者，目前研究提示复方丹参滴丸（由丹参、三七、冰片组成）联合西医常规治疗可能有效。总结CMVD是缺血性心脏病的重要组成部分，近年来研究显示临床CMVD患者广泛存在，其症状表现多样、机制复杂、预后不良，诊断和治疗都面临巨大挑战。复方丹参滴丸凭借其循证优势脱颖而出，在临床中常与西药联用作为CMVD的优化治疗手段，并显现出令人满意的疗效，获指南共识推荐，为临床治疗CMVD带来了新的选择。期待未来有更多研究能够提供更高质量的循证医学证据，进而造福更多CMVD患者。来源：医脉通心血管参考文献：1.中国中西医结合杂志,2023,43(9):1029-1039.2.中华医学会心血管病学分会基础研究学组,中国循环杂志, 2017, 32(5):10.3.ACC官网-摘要https://www.abstractsonline.com/pp8/#!/10674/presentation/171604.中国老年医学学会心血管病分会.中国循环杂志,2020.5.梁德坚.中国现代药物应用, 2019, 13(15):2.6.方顺淼.世界中医药,2015(s1):415-416.7.中西医结合心脑血管病杂志.2022.20(21):3481-3490.8.中国中西医结合杂志,2023,43(9):1029-1039.投稿及报料请发邮件到872470254@qq.com稿件要求详询米内微信首页菜单栏商务及内容合作可联系QQ：412539092【分享、点赞、在看】点一点不失联哦

2024-03-04

·NS Medical Devices

Boston Scientific’s Agent DCB gets FDA nod for in-stent restenosis

The Agent DCB is a balloon catheter coated with paclitaxel that delivers a therapeutic dose of medication to the vessel wall, helping to avoid ISR recurrence Boston Scientific's corporate headquarters in Massachusetts, US. (Credit: Boston Scientific Corporation) Boston Scientific has received the US Food and Drug Administration (FDA) approval for the Agent Drug-Coated Balloon (DCB) to treat coronary in-stent restenosis (ISR) in patients with coronary artery disease. The Agent DCB is a balloon catheter coated with paclitaxel that delivers a therapeutic dose of medication to the vessel wall, helping to avoid ISR recurrence. It can be used as an alternative to conventional procedures such as balloon angioplasty, additional layers of stenting, or radiation. The Agent DCB is now said to be the first coronary drug-coated balloon in the US to offer safe, effective options in ISR treatment. The approval follows the FDA’s Breakthrough Device Designation for the technology in 2021. Boston Scientific interventional cardiology therapies president Lance Bates said: “With more than 100,000 patients treated globally to date in both clinical and commercial settings, we are very pleased to introduce this proven therapy as the first drug-coated coronary balloon in the US. “The Agent DCB addresses a critical unmet need by providing a dedicated treatment option for the challenging condition of ISR and we look forward to offering US physicians the opportunity to treat their patients with this novel device.” The approval was based on the positive results from the multicentre, prospective, randomised controlled Agent IDE study. It recruited 600 patients at 40 US sites. The trial met its primary endpoint of target lesion failure (TLF) at 12 months in the prespecified interim analysis of the first 480 enrolled patients. Agent DCB showed statistical superiority to uncoated balloon angioplasty. Other findings were low adverse event rates at 12 months, a 49% reduction in the risk of a heart attack at the target vessel, and zero definite/probable cases of clotting within the stent. Patients with ISR and untreated small artery coronary disease can receive Agent DCB in Europe, certain regions of Asia Pacific, and Latin America. Boston Scientific intends to introduce the technology to the American market in the upcoming months. Last month, the medical device company secured the FDA’s expanded approval for the WaveWriter spinal cord stimulation (SCS) systems.

上市批准临床结果临床研究

2024-02-28

·BioSpace

VahatiCor, Inc. Announces Treatment of the First Patient with the A-FLUX Reducer System®

Innovation for patients suffering from angina due to persistent ischemic heart disease Santa Clara, CA - February 26, 2024 – VahatiCor, Inc., a company dedicated to improving the quality of life of patients with persistent ischemic heart disease, today announced the treatment of the first patient with the A-FLUX Reducer System, a treatment for patients with angina or chest pain. Angina is often caused by reduced blood flow to the heart. This condition can occur in people with or without significant blockages in their large coronary arteries. It is frequently accompanied by decreased blood flow in the very small blood vessels branching off the coronary arteries, a condition known as coronary microvascular dysfunction or microvascular angina. The A-FLUX Reducer implant is placed in the coronary sinus, the largest vein in the heart, and is designed to provide more blood flow to the ischemic portion of the heart and improve patient symptoms and quality of life. The first patient received the A-FLUX Reducer implant through the Special Access Program (SAP) of Health Canada. A prospective multi-center clinical study of the device is scheduled to begin enrollment this year. “We have many interventional or surgical revascularization options for patients with advanced large coronary artery disease. However, a significant proportion still suffer from angina. The A-FLUX Reducer could help to fill that therapeutic void. It was an honor to perform the first-in-human implant and the patient is doing great,” said Dr. Jean-Michel Paradis, specialist in coronary and structural interventional cardiology at Quebec Heart and Lung Institute, who co-treated the first patient. “The A-FLUX Reducer System is a promising intervention with the potential to provide a predictable and low-risk treatment for a growing population of patients with angina symptoms that do not respond well to medicines and lifestyle changes,” added Dr. Can Manh Nguyen, interventional cardiologist who co-treated the first patient with Dr. Paradis. More than 20 million people in North America and Europe have ongoing angina symptoms and 4 million undergo invasive diagnostic angiograms per year.1-4 “At VahatiCor, we’re driven to improve patient outcomes with solutions that provide rapid relief and long-term effectiveness. While many interventions are available to treat the blockages in the large coronary arteries, very few options exist for an even larger group of patients with microvascular angina,” said Howard Edelman, CEO of VahatiCor. “We are encouraged by the positive early clinical experience with A-FLUX and are moving forward quickly to a larger study that will support the availability of the device for more patients.” About VahatiCor, Inc. VahatiCor, Inc., a member of the T45 Labs portfolio, is developing medical devices that address unmet clinical needs to elevate the standard of care for people with angina and other heart conditions. The team at VahatiCor recognizes the profound impact these conditions can have on a patient’s health, happiness, and overall quality of life and is dedicated to finding solutions. ### The A-FLUX Reducer System is an investigational medical device that is not available for commercial distribution. Media Contact Mark Niggli, CCO media@vahaticor.com 1. Mozaffarian D, et al. Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation. 2016; 133:e38–e360 2. European Society of Cardiology, Disease of the smallest heart blood vessels is important global health problem. 27 May 2021. 3. Cook S, Walker A, Hügli O, Togni M, Meier B. Percutaneous coronary interventions in Europe: prevalence, numerical estimates, and projections based on data up to 2004. Clin Res Cardiol. 2007;96(6):375 382. 4. Patel MR, Peterson ED, Dai D, et al. Low diagnostic yield of elective coronary angiography. N Engl J Med. 2010;362(10):886 895.

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