1．心筋虚血の病態と冠血流の生理学的評価
虚血性心疾患は，冠動脈の狭窄ないしは閉塞により引き起こされる疾患であり，冠動脈造影が診断の中心的役割を担ってきた．しかし，冠動脈造影で描出される狭窄が必ずしも心筋虚血を引き起こすとは限らず，血行動態的な評価を追加してはじめて重症度を正しく判定できることも多い．また，通常の冠動脈造影では捉えきれない病態（冠攣縮，微小循環障害，INOCA（ischemia with non-obstructive coronary arteries）ならびにMINOCA（myocardial infarction with non-obstructive coronary arteries））が心筋虚血の原因であ...
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| Published in | 日本内科学会雑誌 Vol. 110; no. 2; pp. 196 - 203 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本内科学会
10.02.2021
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0021-5384 1883-2083 |
| DOI | 10.2169/naika.110.196 |
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| Abstract | 虚血性心疾患は，冠動脈の狭窄ないしは閉塞により引き起こされる疾患であり，冠動脈造影が診断の中心的役割を担ってきた．しかし，冠動脈造影で描出される狭窄が必ずしも心筋虚血を引き起こすとは限らず，血行動態的な評価を追加してはじめて重症度を正しく判定できることも多い．また，通常の冠動脈造影では捉えきれない病態（冠攣縮，微小循環障害，INOCA（ischemia with non-obstructive coronary arteries）ならびにMINOCA（myocardial infarction with non-obstructive coronary arteries））が心筋虚血の原因であることもあり，幅広い視点を持って診断手順を踏むことが必要である． |
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| AbstractList | 虚血性心疾患は，冠動脈の狭窄ないしは閉塞により引き起こされる疾患であり，冠動脈造影が診断の中心的役割を担ってきた．しかし，冠動脈造影で描出される狭窄が必ずしも心筋虚血を引き起こすとは限らず，血行動態的な評価を追加してはじめて重症度を正しく判定できることも多い．また，通常の冠動脈造影では捉えきれない病態（冠攣縮，微小循環障害，INOCA（ischemia with non-obstructive coronary arteries）ならびにMINOCA（myocardial infarction with non-obstructive coronary arteries））が心筋虚血の原因であることもあり，幅広い視点を持って診断手順を踏むことが必要である． |
| Author | 塩野, 泰紹 |
| Author_xml | – sequence: 1 fullname: 塩野, 泰紹 organization: 和歌山県立医科大学循環器内科 |
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| Copyright | 2021 一般社団法人 日本内科学会 |
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| DOI | 10.2169/naika.110.196 |
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| References | 2) De Rosa S, et al: Diagnostic performance of the instantaneous wave-free ratio: comparison with fractional flow reserve. Circ Cardiovasc Interv 11: e004613, 2018. 7) Gotberg M, et al: Instantaneous wave-free ratio versus fractional flow reserve to guide PCI. N Engl J Med 376: 1813-1823, 2017. 3) Zimmermann FM, et al: Deferral vs. performance of percutaneous coronary intervention of functionally non-significant coronary stenosis: 15-year follow-up of the DEFER trial. Eur Heart J 36: 3182-3188, 2015. 10) Tamis-Holland JE, et al: Contemporary diagnosis and management of patients with myocardial infarction in the absence of obstructive coronary artery disease: a scientific statement from the American Heart Association. Circulation 139: e891-908, 2019. 9) Ong P, et al: International standardization of diagnostic criteria for microvascular angina. Int J Cardiol 250: 16-20, 2018. 4) van Nunen LX, et al: Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial. Lancet 386: 1853-1860, 2015. 1) Pijls NH, et al: Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med 334: 1703-1708, 1996. 6) Davies JE, et al: Use of the instantaneous wave-free ratio or fractional flow reserve in PCI. N Engl J Med 376: 1824-1834, 2017. 5) Xaplanteris P, et al: Five-year outcomes with PCI guided by fractional flow reserve. N Engl J Med 379: 250-259, 2018. 8) Kunadian V, et al: An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group. Eur Heart J 41: 3504-3520, 2020. |
| References_xml | – reference: 7) Gotberg M, et al: Instantaneous wave-free ratio versus fractional flow reserve to guide PCI. N Engl J Med 376: 1813-1823, 2017. – reference: 1) Pijls NH, et al: Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med 334: 1703-1708, 1996. – reference: 8) Kunadian V, et al: An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group. Eur Heart J 41: 3504-3520, 2020. – reference: 2) De Rosa S, et al: Diagnostic performance of the instantaneous wave-free ratio: comparison with fractional flow reserve. Circ Cardiovasc Interv 11: e004613, 2018. – reference: 9) Ong P, et al: International standardization of diagnostic criteria for microvascular angina. Int J Cardiol 250: 16-20, 2018. – reference: 10) Tamis-Holland JE, et al: Contemporary diagnosis and management of patients with myocardial infarction in the absence of obstructive coronary artery disease: a scientific statement from the American Heart Association. Circulation 139: e891-908, 2019. – reference: 4) van Nunen LX, et al: Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial. Lancet 386: 1853-1860, 2015. – reference: 3) Zimmermann FM, et al: Deferral vs. performance of percutaneous coronary intervention of functionally non-significant coronary stenosis: 15-year follow-up of the DEFER trial. Eur Heart J 36: 3182-3188, 2015. – reference: 6) Davies JE, et al: Use of the instantaneous wave-free ratio or fractional flow reserve in PCI. N Engl J Med 376: 1824-1834, 2017. – reference: 5) Xaplanteris P, et al: Five-year outcomes with PCI guided by fractional flow reserve. N Engl J Med 379: 250-259, 2018. |
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| SubjectTerms | INOCA MINOCA 急性冠症候群（ACS） 慢性冠症候群（CCS） 虚血性心疾患 |
| Title | 1．心筋虚血の病態と冠血流の生理学的評価 |
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