Refractory Angina: From Pathophysiology to New Therapeutic Nonpharmacological Technologies.,JACC: Cardiovascular Interventions

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Refractory Angina: From Pathophysiology to New Therapeutic Nonpharmacological Technologies.
JACC: Cardiovascular Interventions ( IF 11.7 ) Pub Date : 2020-01-13 , DOI: 10.1016/j.jcin.2019.08.055
Guglielmo Gallone ₁ , Luca Baldetti ₂ , Georgios Tzanis ₂ , Mario Gramegna ₂ , Azeem Latib ₃ , Antonio Colombo ₄ , Timothy D Henry ₅ , Francesco Giannini ₄

Affiliation

Despite optimal combination of guideline-directed anti-ischemic therapies and myocardial revascularization, a substantial proportion of patients with stable coronary artery disease continues to experience disabling symptoms and is often referred as "no-option." The appraisal of the pathways linking ischemia to symptom perception indicates a complex model of heart-brain interactions in the generation of the subjective anginal experience and inspired novel approaches that may be clinically effective in alleviating the angina burden of this population. Conversely, the prevailing ischemia-centered view of angina, with the focus on traditional myocardial revascularization as the sole option to address ischemia on top of medical therapy, hinders the experimental characterization and broad-scale clinical implementation of strongly needed therapeutic options. The interventionist, often the first physician to establish the diagnosis of refractory angina pectoris (RAP) following coronary angiography, should be aware of the numerous emerging technologies with the potential to improve quality of life in the growing population of RAP patients. This review describes the current landscape and the future perspectives on nonpharmacological treatment technologies for patients with RAP, with a view on the underlying physiopathological rationale and current clinical evidence.

中文翻译：

难治性心绞痛：从病理生理学到新的非药物治疗技术。

尽管有指导抗缺血治疗和心肌血运重建的最佳组合，但稳定的冠心病患者中仍有相当一部分继续出现致残症状，通常被称为“无选择”。对将缺血与症状感知联系起来的途径的评估表明，在主观性心绞痛经验的产生中，心脑相互作用的模型很复杂，并且启发了可能在临床上有效减轻这一人群的心绞痛负担的新颖方法。相反，目前以心绞痛为中心的以缺血为中心的流行观点，将重点放在传统的心肌血运重建上，是在药物治疗之上解决缺血的唯一选择，阻碍了急需的治疗选择的实验表征和大规模临床应用。介入医师通常是在冠状动脉造影后确定难治性心绞痛（RAP）诊断的第一位医师，应该意识到众多新兴技术，它们有可能改善日益增长的RAP患者群体的生活质量。这篇综述描述了RAP患者非药物治疗技术的现状和未来前景，并探讨了潜在的生理病理学原理和当前的临床证据。我们应该意识到在不断增长的RAP患者群体中有可能改善生活质量的众多新兴技术。这篇综述描述了RAP患者非药物治疗技术的现状和未来前景，并探讨了潜在的生理病理学原理和当前的临床证据。我们应该意识到在不断增长的RAP患者群体中有可能改善生活质量的众多新兴技术。这篇综述描述了RAP患者非药物治疗技术的现状和未来前景，并探讨了潜在的生理病理学原理和当前的临床证据。

更新日期：2020-01-07

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