cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2020-1-2391cardiovascular-2391Research ArticleОБЗОРЫREVIEWSВазоспастическая стенокардия: патофизиологические детерминанты и клиническое значениеVasospastic angina: pathophysiology and clinical significancehttps://orcid.org/0000-0002-9250-557XГельцерБ. И.GeltserB. I.

Гельцер Борис Израйльевич — доктор медицинских наук, профессор, член-корреспондент РАН, директор департамента клинической медицины школы биомедицины.

Владивосток

Vladivostok

boris.geltser@vvsu.ruhttps://orcid.org/0000-0003-3545-3862ЦиванюкМ. М.TsivanyukM. M.

Циванюк Михаил Михайлович — аспирант школы биомедицины, врач отделения рентгенохирургических методов диагностики и лечения, кардиолог ВКБ № 1.

Тел.: +7 (914) 791-60-63

m_tsivanyuk@list.ruhttps://orcid.org/0000-0001-5830-1322КотельниковВ. Н.KotelnikovV. N.

Котельников Владимир Николаевич — доктор медицинских наук, профессор департамента клинической медицины школы биомедицины.

Владивосток

Vladivostok

671235@mail.ruhttps://orcid.org/0000-0002-7011-4316КарповР. С.KarpovR. S.

Карпов Ростислав Сергеевич — доктор медицинских наук, профессор, академик РАН, научный руководитель НИИ кардиологии

karpov@cardio-tomsk.ruФГАОУ ВО Дальневосточный федеральный университетFar Eastern Federal UniversityФГАОУ ВО Дальневосточный федеральный университет; КГБУЗ Владивостокская клиническая больница № 1Far Eastern Federal University; Vladivostok clinical hospital №1ФГБНУ Томский национальный исследовательский медицинский центр Российской академии наукTomsk National Research Medical Center20200303202019199105Copyright © Гельцер Б.И., Циванюк М.М., Котельников В.Н., Карпов Р.С., 20202020Гельцер Б.И., Циванюк М.М., Котельников В.Н., Карпов Р.С.Geltser B.I., Tsivanyuk M.M., Kotelnikov V.N., Karpov R.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/2391

В обзоре представлен анализ научной литературы по различным аспектам патогенеза — диагностики и лечения вазоспастической стенокардии (ВС). Приведены данные о распространенности спазма коронарных артерий (СКА) в различных популяциях, а также факторах риска и провоцирующих триггерах. Рассмотрены патофизиологические механизмы СКА, включающие гиперреактивность гладкомышечных клеток коронарных артерий, эндотелиальную дисфункцию, неспецифическое воспаление, окислительный стресс, дефицит магния, вегетативный дисбаланс и др. Подчеркнута взаимосвязь СКА с коронарным тромбозом и атеросклерозом коронарных артерий. Представлены современные алгоритмы диагностики и лечения ВС. Инвазивную верификацию СКА осуществляют путем проведения провокационных фармакологических тестов, которые имеют противопоказания. Ключевая роль в терапии ВС принадлежит антагонистам кальция и их комбинации с пролонгированными нитратами. К препаратам, имеющим перспективу применения при ВС, относят ингибиторы Rho-киназы, активаторы аденозинтрифосфат-чувстви-тельных К+-каналов, антагонисты альфа-1-адренорецепторов. Обсуждаются особенности ведения больных с рефрактерной ВС и перспективы эндоваскулярного лечения. Отмечено, что больные ВС с многососудистым спазмом имеют более высокую вероятность развития жизнеугрожающих аритмий и внезапной смерти.

The review discusses an analysis of the literature on various aspects of the pathogenesis, diagnosis and treatment of vasospastic angina (VA). Data on the prevalence of coronary artery spasm (CAS) in various populations, as well as risk factors and triggers, are presented. We considered pathophysiological mechanisms of CAS, including hyperreactivity of coronary smooth muscle cells, endothelial dysfunction, nonspecific inflammation, oxidative stress, magnesium deficiency, autonomic imbalance, etc. The relationship of CAS with coronary atherosclerosis and thrombosis is emphasized. Modern recommendations for the diagnosis and treatment of VA are presented. Invasive verification of CAS is performed by pharmacological provocation tests with certain contraindications. Calcium antagonists and their combination with long-acting nitrates play a key role in the treatment of VA. Medications with a prospect for use in VA are Rho-kinase inhibitors, ATP-sensitive potassium channel activators, alpha-1 blockers. The management of patients with refractory VA and the prospects for endovascular treatment are discussed. It was noted that patients with multi-vessel VA are more likely to develop life-threatening arrhythmias and sudden death.

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The authors declare that there are no conflicts of interest present.