冠状动脉微血管疾病的诊断与治疗中国专家共识(2023版)-英文版.pdf
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1、Received:24 August 2023Revised:11 November 2023Accepted:16 November 2023DOI:10.1002/mco2.438REVIEWChinese expert consensus on the diagnosis and treatmentof coronary microvascular diseases(2023 Edition)Wenqiang Chen1Mei Ni1He Huang2Hongliang Cong3Xianghua Fu4Wei Gao5Yuejin Yang6Mengyue Yu6Xiantao Son
2、g7Meilin Liu8Zuyi Yuan9Bo Zhang10Zhaohui Wang11Yan Wang12Yundai Chen13,Cheng Zhang1,Yun Zhang1,1The National Key Laboratory for Innovation and Transformation of Luobing Theory,The Key Laboratory of Cardiovascular Remodeling andFunction Research,Chinese Ministry of Education,Chinese National Health C
3、ommission and Chinese Academy of Medical Science,Department ofCardiology,Qilu Hospital of Shandong University,Jinan,Shandong,China2Department of Cardiology,Sir Run Run Shaw Hospital affiliated with Zhejiang University School of Medicine,Hangzhou,China3Department of Cardiology,Tianjin Chest Hospital,
4、Tianjin University,Tianjin,China4Department of Cardiology,The Second Hospital of Hebei Medical University,Shijiazhuang,Hebei,China5Department of Cardiology,Peking University Third Hospital,Beijing,China6Department of Cardiology,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Acade
5、my of Medical Sciences and Peking UnionMedical College,Beijing,China7Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing,China8Department of Geriatrics,Peking University First Hospital,Beijing,China9Department of Cardiology,The First Affiliated Hospital of Xian Jiaoto
6、ng University,Xian,China10Department of Cardiology,First Affiliated Hospital,Dalian Medical University,Dalian,Liaoning,China11Department of Cardiology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,China12Department of Cardiology,Xiamen Cardiovascular Hospi
7、tal,Xiamen University,Xiamen,China13Senior Department of Cardiology,Sixth Medical Center of Chinese PLA General Hospital,Beijing,China;for the Basic Research Group,Atherosclerosis and Coronary Heart Disease Group,Interventional Cardiology Group,and Womens Heart Health Group of the Chinese Society of
8、CardiologyCorrespondenceCheng Zhang,Department of Cardiology,Qilu Hospital,Shandong University,No.107,Wen Hua Xi Road,Jinan,Shandong250012,China.Email:Yundai Chen,Senior Department ofCardiology,Sixth Medical Center ofChinese PLA General Hospital,No.6,Fucheng Road,Haidian District,Beijing100048,China
9、.Email:Yun Zhang,Deparment of Cardiology,Qilu Hospital,Shandong University,No.AbstractSince the four working groups of the Chinese Society of Cardiology issued firstexpert consensus on coronary microvascular diseases(CMVD)in 2017,interna-tional consensus documents on CMVD have increased rapidly.Alth
10、ough someof these documents made preliminary recommendations for the diagnosis andtreatment of CMVD,they did not provide classification of recommendationsand levels of evidence.In order to summarize recent progress in the field ofCMVD,standardize the methods and procedures of diagnosis and treatment
11、,and identify the scientific questions for future research,the four working groupsof the Chinese Society of Cardiology updated the 2017 version of the Chineseexpert consensus on CMVD and adopted a series of measures to ensure theThis is an open access article under the terms of the Creative Commons
12、Attribution License,which permits use,distribution and reproduction in any medium,provided theoriginal work is properly cited.2023 The Authors.MedComm published by Sichuan International Medical Exchange&Promotion Association(SCIMEA)and John Wiley&Sons Australia,Ltd.MedComm.2023;4: of 40https:/doi.or
13、g/10.1002/mco2.4382 of 40CHEN et al.107,Wen Hua Xi Road,Jinan,Shandong250012,China.Email:Funding informationNational Natural Science Foundation ofChina,Grant/Award Numbers:82241203,81920108003,82030051;State Key R&DProgram,Chinese Ministry of Science andTechnology,Grant/Award Number:2021YFF0501403;K
14、ey R&D Program,Shandong Provincial Department ofScience and Technology,Grant/AwardNumbers:2021SFGC0503,2021ZLGX02,2021ZDSYS05,2020ZLYS05;NaturalScience Foundation,Shandong ProvincialDepartment of Science and Technology,Grant/Award Number:ZR202102190727;Taishan Scholars Program,ShandongProvincial Dep
15、artment of Science andTechnology,Grant/Award Number:(ZhangC.)qualityofthisdocument.ThecurrentconsensushasraisedanewclassificationofCMVD,summarized new epidemiological findings for different types of CMVD,analyzed key pathological and molecular mechanisms,evaluated classical andnovel diagnostic techn
16、ologies,recommended diagnostic pathways and criteria,and therapeutic strategies and medications,for patients with CMVD.In view ofthe current progress and knowledge gaps of CMVD,future directions were pro-posed.It is hoped that this expert consensus will further expedite the researchprogress of CMVD
17、in both basic and clinical scenarios.KEYWORDScoronary microvascular disease,myocardial ischemia,myocardial infarction,atherosclerosis,non-atherosclerotic heart disease,Chinese expert consensus1INTRODUCTIONSinceLikoffetal.1firstreportedtheclinicalmanifestationsof a group of patients with a definite d
18、iagnosis of coronaryheart disease(CHD)but a normal coronary angiogram in1967,basic and clinical research on coronary microvascu-lar diseases(CMVD)has continued for half a century.In2013,the European Society of Cardiology(ESC)guidelinesfor the treatment of stable coronary artery disease(CAD)first rec
19、ognized CMVD as a clinical type of CHD andmade preliminary recommendations for the diagnosis andtreatment of CMVD.2In 2017,the Basic Research Group,Interventional Cardiology Group,Womens Heart HealthGroup,and Atherosclerosis and Coronary Heart DiseaseGroup of the Chinese Society of Cardiology issued
20、“Chi-nese expert consensus on the diagnosis and treatment ofcoronary microvascular diseases,”the first expert consen-sus on CMVD in the literature,3which clarified a numberof unclear issues and expedited the progress of basic andclinical research in the field of CMVD in China.Since 2017,internationa
21、l consensus documents onCMVDhaveincreasedrapidly.In2018,theCoronaryVaso-motion Disorders International Study Group(COVADIS)recommended the diagnostic criteria for type 1 coro-nary artery microvascular dysfunction,namely primaryCMVD.4In 2019,the ESC published guidelines for thediagnosis and treatment
22、 of chronic coronary syndrome,in which microvascular angina(MVA)pectoris was classi-fied as an important type of chronic coronary syndrome,and corresponding diagnostic and treatment strategieswere recommended.5In 2019,the American Heart Asso-ciation(AHA)issued a scientific statement on the diag-nosi
23、s and treatment of myocardial infarction(MI)withnonobstructive coronary arteries(MINOCA),stating thatMVA pectoris,micro-vasospasm,and slow coronary floware important causes of MINOCA.6In 2020,the Euro-pean Association of Percutaneous Cardiovascular Inter-ventions(EAPCI)and ESC jointly issued a conse
24、nsus doc-ument on ischemia with nonobstructive coronary arteries(INOCA),indicating that CMVD and epicardial coronaryartery spasm are the main causes of INOCA.7In 2020,ESC Working Group on Coronary Pathophysiology andMicrocirculation published position paper on coronarymicrovascular dysfunction,divid
25、ing CMVD into six clin-ical types.8These international documents focused onmainly research progress of CMVD,and although some ofthese documents made preliminary recommendations forthediagnosisandtreatmentofCMVD,theydidnotprovideclassification of recommendations and levels of evidence.Thus,the guidan
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