Вазоспастическая стенокардия: патофизиологические детерминанты и клиническое значение

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.

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