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Современная инструментальная диагностика ишемической болезни сердца у женщин и ее прогностическое значение
Современная инструментальная диагностика ишемической болезни сердца у женщин и ее прогностическое значение
Лупанов В.П. Современная инструментальная диагностика ишемической болезни сердца у женщин и ее прогностическое значение. Consilium Medicum. 2018; 20 (1): 27–32. DOI: 10.26442/2075-1753_2018.1.27-32
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Аннотация
Половые различия в сердечно-сосудистых заболеваниях имеют жизненно важное значение для оптимальной диагностики и лечения, особенно у женщин. Существует и одновременно растет понимание многофакторной природы ишемической болезни сердца (ИБС) у многих пациенток, у которых заболевание может распространяться за пределы эпикарда коронарных артерий. В то время как в отношении обструктивного заболевания коронарных артерий остается гиподиагностика, у женщин также присутствует и необструктивное поражение коронарных артерий. Микрососудистая дисфункция, спазм коронарных артерий и коронарная диссекция встречаются чаще у женщин, чем у мужчин. В обзоре рассматриваются диагностика ИБС у женщин и значение современных неинвазивных методов, используемых для стратификации риска у женщин с подозрением на ИБС.
Ключевые слова: стабильная ишемическая болезнь сердца, женщины, инструментальная диагностика, пробы с физической нагрузкой, методы визуализации миокарда, коронарные артерии, прогноз.
Ключевые слова: стабильная ишемическая болезнь сердца, женщины, инструментальная диагностика, пробы с физической нагрузкой, методы визуализации миокарда, коронарные артерии, прогноз.
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Recent decades have seen a growing recognition that the understanding of sex differences in cardiovascular disease is vital to optimal diagnosis and management, particularly of women. There is simultaneously an increasing appreciation of the multifactorial nature of ischemic heart disease (IHD) in many patients, in whom disease may extend beyond the epicardial coronaries. While obstructive coronary artery disease (CAD) remains underdiagnosed in women and still represents a major burden of disease, women also present with nonobstructive CAD more commonly than men. Indeed, microvascular dysfunction, coronary artery vasospasm, and coronary dissections contribute to a larger proportion of IHD in women than men. Here, we review the symptom presentation of women with IHD and the noninvasive modalities used to risk stratify women with suspected IHD.
Key words: stable ischemic heart disease, women, instrumental diagnostics, exercise stress test, methods of myocardial imaging, coronary arteries, prognosis.
Key words: stable ischemic heart disease, women, instrumental diagnostics, exercise stress test, methods of myocardial imaging, coronary arteries, prognosis.
Полный текст
Список литературы
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1. Lupanov V.P., Nuraliev E.Yu., Sergienko I.V. Functional stress tests in the diagnosis of coronary heart disease, assessing the risk of complications and prognosis. M.: PatiSS, 2016. [in Russian]
2. Guide to medical treatment of cardiovascular diseases. Ed. E.I.Chazov. M.: Practica, 2015. [in Russian]
3. Bairey Merz CN, Shaw LJ, Reis SE et al. Insights from the NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation (WISE) Study: Part II: gender differences in presentation, diagnosis, and outcome with regard to gender-based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease. J Am Coll Cardiol 2006; 47 (Suppl. 3): S21.
4. Montalescot G, Sechtem U, Achenbach S et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable Coronary artery disease of European Society of Cardiology. Eur Heart J 2013; 34: 2949–3003.
5. Mieres JH, Gulati M, Bairey Merz N et al. Role of noninvasive testing in the clinical evaluation of women with suspected ischemic heart disease: a consensus statement from the American Heart Association. Circulation 2014; 130 (4): 350–79.
6. Lupanov V.P. Modern non-invasive diagnostics of coronary heart disease in female patients. Terapevt. 2011; 12: 33–8. [in Russian]
7. Lau ES, Sarma A. Utility of Imaging in Risk Stratification of Chest Pain in Women. Curr Treat Options Cardiovasc Med 2017; 19 (9): 72. DOI: 10.1007/s 11936-017-0568-9
8. Pathak LA, Shirodrar S, Ruparelia R, Rajebahadur. Coronary artery disease in women. Indian Heart J 2017; 69: 532–53.
9. G.V.Ryabykina. Loading Tests in Cardiologic Clinic. Terapevt. 2010; 11: 51–76. [in Russian]
10. Hemal K, Pagidipati NJ, Coles A et al. Sex Differences in Demographics, Risk Factors, Presentation, and Noninvasive Testing in Stable Outpatients With Suspected Coronary Artery Disease: Insights From the PROMISE Trial. JACC Cardiovas Imag 2016; 9 (4): 337–46.
11. Cumming GR, Dufresne C, Kich I, Samm J. Exercise electrocardiogram patterns in normal women. Br Heart J 1973; 35 (10): 1055–61.
12. Mosca L, Barrett-Connor E, Wenger NK. Sex/gender differences in cardiovascular disease prevention: what a difference a decade makes. Circulation 2011; 124 (19): 2145–54.
13. Kwok Y, Kim C, Grady D et al. Meta-analysis of exercise testing to detect coronary artery disease in women. Amer J Cardiol 1999; 83 (5): 660–66.
14. Astrand I. Exercise electrocardiograms recorder twice with an 8-years interval in group of 204 women and men 48–63 years old. Acta Medica Scandinavica 1965; 178: 27–39.
15. Higgins JP, Higgins JA. Electrocardiographic exercise stress testing: an update beyond the ST segment. Int J Cardiol 2007; 116 (3): 285–99.
16. Grzybowski A, Puchalski W, Zieba B et al. How to improve noninvasive coronary artery disease diagnostics in premenopausal women? The influence of menstrual cycle on ST depression, left ventricle contractility, and chest pain observed during exercise echocardiography in women with angina and normal coronary angiogram. Am Heart J 2008; 156 (5): 964.e1-e5.
17. Morise AP, Beto R. The specificity of exercise electrocardiography in women grouped by estrogen status. Int J Cardiol 1997; 60 (1): 55–65.
18. Mattingly TW. The postexercise electrocardiogram. Its value in the diagnosis and prognosis of coronary arterial disease. Am J Cardiol 1962; 9: 395–400.
19. Gulati M, Shaw LJ, Thisted RA at al. Heart rate response to exercise stress testing in asymptomatic women: the St. James Women Take Heart Project. Circulation 2010; 122 (2): 130–7.
20. Pratt CM, Francis MJ, Divine GW, Young JB. Exercise testing in women with chest pain. Are there exercise characteristics that predict true positive test results? Chest 1989; 95 (1): 139–44.
21. Mark DB, Shaw L, Harrell FE et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med 1991; 325: 849–53.
22. Gulati M, Arnsdorf MF, Shaw LJ et al. Prognostic value of the duke treadmill score in asymptomatic women. Am J Cardiol 2005; 6 (3): 369–5.
23. Vermeltfoort IA, Bondarenko O, Raijmakers PG et al. Is subendocardial ischemia present in patients with chest pain and normal coronary angiograms? A cardiovascular MR study. Eur Heart J 2007: 28 (13): 1554–8.
24. Sanmarсo ME, Pontius S, Selvester RH. Abnormal blood pressure response and marked ischemic ST-segment depression as predictors of severe coronary artery disease. Circulation 1980; 61 (3): 572–8.
25. Allison TG, Cordeiro MA, Miller TD et al. Prognostic significance of exercise-induced systemic hypertension in healthy subjects. Am J Cardiol 1999; 83 (3): 371–5.
26. Lauer МS, Pashkow FJ, Harvey SS et al. Angiographic and prognostic implications of an exaggerated exercise systolic blood pressure response and rest systolic blood pressure in adults undergoing evaluation for suspected coronary artery disease. J Am Coll Cardiol 1995; 26 (7): 1630–6.
27. Shaw LJ, Bugiardini R, Merz CN. Women and ischemic heart disease: evolving knowledge. J Am Coll Cardiol 2009; 54 (17): 1561–75.
28. Карпова И.Е., Соболева Г.Р., Самойленко Л.Е., Карпов Ю.А. Современные методы диагностики ишемии миокарда у больных с кардиальным синдромом Х. Кардиологический вестн. 2017; 2: 57–60. / Кarpova I.E., Soboleva G.N., Samoilenko L.E., Karpov Yu.A. Advanced diagnostic method of Cardiac syndrom X. Kardiologicheskij vestn. 2017; 2: 57–60. [in Russian]
29. Voronina V.P., Kiseleva N.V., Martsevich S.Yu. Exercise tests in cardiology: Past, Present and Future. Part I–III. Cardiovascular therapy and prevention. 2015; 14 (2): 80–6; 2015;14 (3):82–8; 2015, 14 (6): 93–100. [in Russian]
30. Lupanov V.P. Diagnostic and prognostic role of the modern instrumental methods for cardiovascular examination in patients with coronary heart disease (review). Cardiovascular therapie and profilaction. 2011; 5: 106–15. [in Russian]
31. Pillikka PA, Nagueh SF, Elhendy AA et al. Sex differences in the performance of cardiac computed tomography compared with functional testing in evaluation stable chest pain: subanalysis of the multicenter randodomized CRESCENT Trial. Calcium Imaging and Selective CT Angiography in Comparison to Functional Testing for Suspected Coronary Artery Disease. Circ Cardiovasc Imaging 2017; 10 (2): e005295.
32. Arruda-Olson AM, Juracan EM, Mahoney DW et al. Prognostic value of exercise echocardiography in 5,798 patients: is there a gender difference? J Am Coll Cardiol 2002; 39 (4): 625–31.
33. Fleischmann KE, Hunink MG, Kuntz KM, Douglas PS. Exercise echocardiography or exercise SPECT imaging? A meta-analysis of diagnostic test performance. JAMA 1998; 280 (10): 913–20.
34. Dolor RJ, Patel MR, Melloni C et al. AHRQ Comparative Effectiveness Reviews. Noninvasive Technologies for the Diagnosis of Coronary Artery Disease in Women. Rockville: Agency for Healthcare Research and Quality (US), 2012.
35. Metz LD, Beattie M, Hom R et al. The prognostic value of normal exercise myocardial perfusion imaging and exercise echocardiography: a meta-analysis. J Am Coll Cardiol 2007; 49 (2): 227–37.
36. Aggeli C, Polytarchou K, Felekos I et al. The impact of gender on the prognostic value of dobutamine stress myocardial contrast echocardiography. Hellenic J Cardiol – Hellenike Kardiologike Epitheorese 2017. DOI: 10.1016/j.hjc.2017.04.004
37. Mieres JH, Shaw LJ, Hendel RC et al. American Society of Nuclear Cardiology consensus statement: task force on women and coronary artery disease–the role of myocardial perfusion imaging in the clinical evaluation of coronary artery disease in women [correction]. J Nucl Cardiol Off Publ. Am Soc Nucl Cardiol 2003; 10 (1): 95–101.
38. Lupanov V.P., Nuraliev E.Yu. Modern methods of instrumental research of patients by stable ischemic heart trouble at the protracted supervisions (new American recommendations on diagnostics and treatment of stable ischemic heart 2012 trouble). Rus. med. zhurn. 2013; 12: 601–5. [in Russian]
39. Sinitsyn V. E., Ternovoy S.K. Magnetically-resonance tomography of the heart in the new century. Radiology-practice. 2005; 4: 17–22. [in Russian]
40. Kohli P, Gulati M. Exercise stress testing in women. Going back to the basis. Circulation 2010; 122: 2570–80.
41. Esteves FP, Travin MI. The role of nuclear cardiology in the diagnosis and risk stratification of women with ischemic heart disease. Semin Nucl Med 2014; 44 (6): 423–38.
42. Ansheles A.A., Shulgin D.N., Solomyany V.V., Sergienko V.B. Cоmparison of stress-test, single- photon emission computed tomography and coronarography results in IHD patients. Kardiologicheskij Vestn. 2012; 2: 10–6.[in Russian]
43. McSweeney JC, Rosenfeld AG, Abel WM et al. Preventing and experiencing ischemic heart disease as a woman: state of the science: a scientific statement from the American Heart Association. Circulation 2016; 133 (13): 1302–3.
44. Nguyen PK, Nag D, Wu JC. Sew differences in the diagnostic evaluation of coronary artery disease. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol 2011; 18 (1): 144–52.
45. Lupanov V.P., Magomedov M.A., Alekseeva I.A. et al. Diagnostics and treatment of coronary heart disease in aged female patient with atypical stenocardia (clinical observation). Terapevt. 2012; 6: 49–57. [in Russian]
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48. Hausleiter J, Meуеr T, Нermann F et al. Estimated radiation dose associated with cardiac CT angiograрhу. JAMA 2009: 301 (5): 550–7.
49. Nikiforov V.S. Methods of cardiovascular imaging for the detection of ischemic heart disease. Consilium Medicum. 2017; 19 (1): 18–24. [in Russian]
50. Dolor RJ, Patel MR, Melloni C et al. AHRQ Comparative Effectiveness Reviews. Noninvasive Technologies for the Diagnosis of Coronary Artery Disease in Women. Rockville: Agency for Healthcare Research and Quality (US), 2012.
51. Lubbers M, Coenen A, Bruning T et al. Sex differences in the performance of computed tomography with functional testing in evaluating stable chest pain: subanalysis of the multicenter, randomized CRESCENT Trial (Calcium Imaging and Selective CT angiography in Comparison for Functional Testing for Suspected Coronary Artery Disease). Circ Cardiovasc Imaling 2017; 10 (2): e005295.
52. Tweet MS, Gulati R, Williamson EE et al. Multimodality imaging for spontaneous coronary artery dissection in women. JACC Cardiovasc Imaging 2016; 9 (4): 436–50.
53. Vaidya GN. Application of exercise ECG stress test in the current high cost modern-era healthcare system. Indian Heart J 2017; 69: 551–5.
54. Aronov D.M, Lupanov V.P. Functional stress tests in cardiology. In: Cardiology: national leadership. 2-nd ed. revised. and ext. Ed. E.V.Shlyakhto. M.: GEOTAR-Media, 2015. s. 95–3. [in Russian]
55. Marwan M, Ropers D, Pflederer N et al. Clinical characteristics of patients with obstructive coronary lesions in the absence of coronary calcification: an evaluluation by coronary CT angiography. Heart 2009; 95: 1056–60.
Авторы
В.П.Лупанов
ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России. 121552, Россия, Москва, ул. 3-я Черепковская, д. 15А
Lupanovvp@mail.ru
National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation. 121552, Russian Federation, Moscow, ul. 3-ia Cherepkovskaia, d. 15a
Lupanovvp@mail.ru
________________________________________________
V.P.Lupanov
National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation. 121552, Russian Federation, Moscow, ul. 3-ia Cherepkovskaia, d. 15a
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.