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29.06.2016 | ORIGINAL ARTICLE

Treatment of Angina Pectoris Associated with Coronary Microvascular Dysfunction

verfasst von: Peter Ong, Anastasios Athanasiadis, Udo Sechtem

Erschienen in: Cardiovascular Drugs and Therapy | Ausgabe 4/2016

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Abstract

Treatment of angina pectoris associated with coronary microvascular dysfunction is challenging as the underlying mechanisms are often diverse and overlapping. Patients with type 1 coronary microvascular dysfunction (i.e. absence of epicardial coronary artery disease and myocardial disease) should receive strict control of their cardiovascular risk factors and thus receive statins and ACE-inhibitors in most cases. Antianginal medication consists of ß-blockers and/or calcium channel blockers. Second line drugs are ranolazine and nicorandil with limited evidence. Despite individually titrated combinations of these drugs up to 30 % of patients have refractory angina. Rho-kinase inhibitors and endothelin-receptor antagonists represent potential drugs that may prove useful in these patients in the future.
Literatur
1.
2.
Zurück zum Zitat Lanza GA, Camici PG, Galiuto L, Niccoli G, Pizzi C, di Monaco a, Sestito a, novo S, Piscione F, Tritto I, Ambrosio G, Bugiardini R, Crea F, Marzilli M, Gruppo di studio di Fisiopatologia Coronarica e Microcircolazione, Società Italiana di Cardiologia. Methods to investigate coronary microvascular function in clinical practice. J Cardiovasc Med (Hagerstown). 2013;14:1–18.CrossRef Lanza GA, Camici PG, Galiuto L, Niccoli G, Pizzi C, di Monaco a, Sestito a, novo S, Piscione F, Tritto I, Ambrosio G, Bugiardini R, Crea F, Marzilli M, Gruppo di studio di Fisiopatologia Coronarica e Microcircolazione, Società Italiana di Cardiologia. Methods to investigate coronary microvascular function in clinical practice. J Cardiovasc Med (Hagerstown). 2013;14:1–18.CrossRef
3.
Zurück zum Zitat Lamendola P, Lanza GA, Spinelli A, Sgueglia GA, Di Monaco A, Barone L, Sestito A, Crea F. Long-term prognosis of patients with cardiac syndrome X. Int J Cardiol. 2010;140:197–9.CrossRefPubMed Lamendola P, Lanza GA, Spinelli A, Sgueglia GA, Di Monaco A, Barone L, Sestito A, Crea F. Long-term prognosis of patients with cardiac syndrome X. Int J Cardiol. 2010;140:197–9.CrossRefPubMed
4.
Zurück zum Zitat Reis SE, Holubkov R, Conrad smith AJ, Kelsey SF, Sharaf BL, Reichek N, Rogers WJ, Merz CN, Sopko G, Pepine CJ. WISE investigators. Coronary microvascular dysfunction is highly prevalent in women with chest pain in the absence of coronary artery disease: results from the NHLBI WISE study. Am Heart J. 2001;141:735–41.CrossRefPubMed Reis SE, Holubkov R, Conrad smith AJ, Kelsey SF, Sharaf BL, Reichek N, Rogers WJ, Merz CN, Sopko G, Pepine CJ. WISE investigators. Coronary microvascular dysfunction is highly prevalent in women with chest pain in the absence of coronary artery disease: results from the NHLBI WISE study. Am Heart J. 2001;141:735–41.CrossRefPubMed
5.
Zurück zum Zitat Ong P, Athanasiadis A, Borgulya G, Mahrholdt H, Kaski JC, Sechtem U. High prevalence of a pathological response to acetylcholine testing in patients with stable angina pectoris and unobstructed coronary arteries. The ACOVA study (abnormal COronary VAsomotion in patients with stable angina and unobstructed coronary arteries). J Am Coll Cardiol. 2012;59:655–62.CrossRefPubMed Ong P, Athanasiadis A, Borgulya G, Mahrholdt H, Kaski JC, Sechtem U. High prevalence of a pathological response to acetylcholine testing in patients with stable angina pectoris and unobstructed coronary arteries. The ACOVA study (abnormal COronary VAsomotion in patients with stable angina and unobstructed coronary arteries). J Am Coll Cardiol. 2012;59:655–62.CrossRefPubMed
6.
Zurück zum Zitat Pasceri V, Lanza GA, Buffon A, Montenero AS, Crea F, Maseri A. Role of abnormal pain sensitivity and behavioral factors in determining chest pain in syndrome X. J Am Coll Cardiol. 1998;31:62–6.CrossRefPubMed Pasceri V, Lanza GA, Buffon A, Montenero AS, Crea F, Maseri A. Role of abnormal pain sensitivity and behavioral factors in determining chest pain in syndrome X. J Am Coll Cardiol. 1998;31:62–6.CrossRefPubMed
7.
Zurück zum Zitat Lanza GA, Giordano A, Pristipino C, Calcagni ML, Meduri G, Trani C, Franceschini R, Crea F, Troncone L, Maseri A. Abnormal cardiac adrenergic nerve function in patients with syndrome X detected by [123I]metaiodobenzylguanidine myocardial scintigraphy. Circulation. 1997;96:821–6.CrossRefPubMed Lanza GA, Giordano A, Pristipino C, Calcagni ML, Meduri G, Trani C, Franceschini R, Crea F, Troncone L, Maseri A. Abnormal cardiac adrenergic nerve function in patients with syndrome X detected by [123I]metaiodobenzylguanidine myocardial scintigraphy. Circulation. 1997;96:821–6.CrossRefPubMed
8.
Zurück zum Zitat Granger DN, Rodrigues SF, Yildirim A, Senchenkova EY. Microvascular responses to cardiovascular risk factors. Microcirculation. 2010;17:192–205.CrossRefPubMedPubMedCentral Granger DN, Rodrigues SF, Yildirim A, Senchenkova EY. Microvascular responses to cardiovascular risk factors. Microcirculation. 2010;17:192–205.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Vermeltfoort IA1, Raijmakers PG, Riphagen II, Odekerken DA, Kuijper AF, Zwijnenburg A, Teule GJ. Definitions and incidence of cardiac syndrome X: review and analysis of clinical data. Clin Res Cardiol. 2010;99:475–81.CrossRefPubMedPubMedCentral Vermeltfoort IA1, Raijmakers PG, Riphagen II, Odekerken DA, Kuijper AF, Zwijnenburg A, Teule GJ. Definitions and incidence of cardiac syndrome X: review and analysis of clinical data. Clin Res Cardiol. 2010;99:475–81.CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Beltrame JF, Crea F, Kaski JC, Ogawa H, Ong P, Sechtem U, Shimokawa H, Bairey Merz CN; Coronary Vasomotion Disorders International Study Group (COVADIS). International standardization of diagnostic criteria for vasospastic angina. Eur Heart J. 2015 Beltrame JF, Crea F, Kaski JC, Ogawa H, Ong P, Sechtem U, Shimokawa H, Bairey Merz CN; Coronary Vasomotion Disorders International Study Group (COVADIS). International standardization of diagnostic criteria for vasospastic angina. Eur Heart J. 2015
11.
Zurück zum Zitat Members TF, Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C, Ferreira JR, Gersh BJ, Gitt AK, Hulot JS, Marx N, Opie LH, Pfisterer M, Prescott E, Ruschitzka F, Sabaté M, Senior R, Taggart DP, van der Wall EE, Vrints CJ, ESC Committee for Practice Guidelines, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Document Reviewers, Knuuti J, Valgimigli M, Bueno H, Claeys MJ, Donner-Banzhoff N, Erol C, Frank H, Funck-Brentano C, Gaemperli O, Gonzalez-Juanatey JR, Hamilos M, Hasdai D, Husted S, James SK, Kervinen K, Kolh P, Kristensen SD, Lancellotti P, Maggioni AP, Piepoli MF, Pries AR, Romeo F, Rydén L, Simoons ML, Sirnes PA, Steg PG, Timmis A, Wijns W, Windecker S, Yildirir A, Zamorano JL. 2013 ESC guidelines on the management of stable coronary artery disease: the task force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34:2949–3003.CrossRef Members TF, Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C, Ferreira JR, Gersh BJ, Gitt AK, Hulot JS, Marx N, Opie LH, Pfisterer M, Prescott E, Ruschitzka F, Sabaté M, Senior R, Taggart DP, van der Wall EE, Vrints CJ, ESC Committee for Practice Guidelines, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Document Reviewers, Knuuti J, Valgimigli M, Bueno H, Claeys MJ, Donner-Banzhoff N, Erol C, Frank H, Funck-Brentano C, Gaemperli O, Gonzalez-Juanatey JR, Hamilos M, Hasdai D, Husted S, James SK, Kervinen K, Kolh P, Kristensen SD, Lancellotti P, Maggioni AP, Piepoli MF, Pries AR, Romeo F, Rydén L, Simoons ML, Sirnes PA, Steg PG, Timmis A, Wijns W, Windecker S, Yildirir A, Zamorano JL. 2013 ESC guidelines on the management of stable coronary artery disease: the task force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34:2949–3003.CrossRef
12.
Zurück zum Zitat Pizzi C, Manfrini O, Fontana F, Bugiardini R. Angiotensin-converting enzyme inhibitors and 3-hydroxy-3-methylglutaryl coenzyme a reductase in cardiac syndrome X: role of superoxide dismutase activity. Circulation. 2004;109:53–8.CrossRefPubMed Pizzi C, Manfrini O, Fontana F, Bugiardini R. Angiotensin-converting enzyme inhibitors and 3-hydroxy-3-methylglutaryl coenzyme a reductase in cardiac syndrome X: role of superoxide dismutase activity. Circulation. 2004;109:53–8.CrossRefPubMed
13.
Zurück zum Zitat Chen JW1, Hsu NW, Wu TC, Lin SJ, Chang MS. Long-term angiotensin-converting enzyme inhibition reduces plasma asymmetric dimethylarginine and improves endothelial nitric oxide bioavailability and coronary microvascular function in patients with syndrome X. Am J Cardiol. 2002;90:974–982. Chen JW1, Hsu NW, Wu TC, Lin SJ, Chang MS. Long-term angiotensin-converting enzyme inhibition reduces plasma asymmetric dimethylarginine and improves endothelial nitric oxide bioavailability and coronary microvascular function in patients with syndrome X. Am J Cardiol. 2002;90:974–982.
14.
Zurück zum Zitat Pauly DF, Johnson BD, Anderson RD, Handberg EM, Smith KM, Cooper-DeHoff RM, Sopko G, Sharaf BM, Kelsey SF, Merz CN, Pepine CJ. In women with symptoms of cardiac ischemia, nonobstructive coronary arteries, and microvascular dysfunction, angiotensin-converting enzyme inhibition is associated with improved microvascular function: a double-blind randomized study from the National Heart, lung and blood institute Women's ischemia syndrome evaluation (WISE). Am Heart J. 2011;162:678–84.CrossRefPubMedPubMedCentral Pauly DF, Johnson BD, Anderson RD, Handberg EM, Smith KM, Cooper-DeHoff RM, Sopko G, Sharaf BM, Kelsey SF, Merz CN, Pepine CJ. In women with symptoms of cardiac ischemia, nonobstructive coronary arteries, and microvascular dysfunction, angiotensin-converting enzyme inhibition is associated with improved microvascular function: a double-blind randomized study from the National Heart, lung and blood institute Women's ischemia syndrome evaluation (WISE). Am Heart J. 2011;162:678–84.CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Kayikcioglu M, Payzin S, Yavuzgil O, Kultursay H, Can LH, Soydan I. Benefits of statin treatment in cardiac syndrome-X. Eur Heart J. 2003;24:1999–2005.CrossRefPubMed Kayikcioglu M, Payzin S, Yavuzgil O, Kultursay H, Can LH, Soydan I. Benefits of statin treatment in cardiac syndrome-X. Eur Heart J. 2003;24:1999–2005.CrossRefPubMed
16.
Zurück zum Zitat Fábián E, Varga A, Picano E, Vajo Z, Rónaszéki A, Csanády M. Effect of simvastatin on endothelial function in cardiac syndrome X patients. Am J Cardiol. 2004;94:652–5.CrossRefPubMed Fábián E, Varga A, Picano E, Vajo Z, Rónaszéki A, Csanády M. Effect of simvastatin on endothelial function in cardiac syndrome X patients. Am J Cardiol. 2004;94:652–5.CrossRefPubMed
17.
Zurück zum Zitat Zhang X1, Li Q, Zhao J, Li X, Sun X, Yang H, Wu Z, Yang J. Effects of combination of statin and calcium channel blocker in patients with cardiac syndrome X. Coron Artery Dis. 2014;25:40–4.CrossRefPubMed Zhang X1, Li Q, Zhao J, Li X, Sun X, Yang H, Wu Z, Yang J. Effects of combination of statin and calcium channel blocker in patients with cardiac syndrome X. Coron Artery Dis. 2014;25:40–4.CrossRefPubMed
18.
Zurück zum Zitat Lanza GA, Colonna G, Pasceri V, Maseri A. Atenolol versus amlodipine versus isosorbide-5-mononitrate on anginal symptoms in syndrome X. Am J Cardiol. 1999;84:854–6.CrossRefPubMed Lanza GA, Colonna G, Pasceri V, Maseri A. Atenolol versus amlodipine versus isosorbide-5-mononitrate on anginal symptoms in syndrome X. Am J Cardiol. 1999;84:854–6.CrossRefPubMed
19.
Zurück zum Zitat Sen N, Tavil Y, Erdamar H, Yazici HU, Cakir E, Akgül EO, Bilgi C, Erbil MK, Poyraz F, Okyay K, Turfan M, Cemri M. Nebivolol therapy improves endothelial function and increases exercise tolerance in patients with cardiac syndrome X. Anadolu Kardiyol Derg. 2009;9:371–9.PubMed Sen N, Tavil Y, Erdamar H, Yazici HU, Cakir E, Akgül EO, Bilgi C, Erbil MK, Poyraz F, Okyay K, Turfan M, Cemri M. Nebivolol therapy improves endothelial function and increases exercise tolerance in patients with cardiac syndrome X. Anadolu Kardiyol Derg. 2009;9:371–9.PubMed
20.
Zurück zum Zitat Russo G, Di Franco A, Lamendola P, Tarzia P, Nerla R, Stazi A, Villano A, Sestito A, Lanza GA, Crea F. Lack of effect of nitrates on exercise stress test results in patients with microvascular angina. Cardiovasc Drugs Ther. 2013;27:229–34.CrossRefPubMed Russo G, Di Franco A, Lamendola P, Tarzia P, Nerla R, Stazi A, Villano A, Sestito A, Lanza GA, Crea F. Lack of effect of nitrates on exercise stress test results in patients with microvascular angina. Cardiovasc Drugs Ther. 2013;27:229–34.CrossRefPubMed
21.
Zurück zum Zitat Villano A, Di Franco A, Nerla R, Sestito A, Tarzia P, Lamendola P, Di Monaco A, Sarullo FM, Lanza GA, Crea F. Effects of ivabradine and ranolazine in patients with microvascular angina pectoris. Am J Cardiol. 2013;112:8–13.CrossRefPubMed Villano A, Di Franco A, Nerla R, Sestito A, Tarzia P, Lamendola P, Di Monaco A, Sarullo FM, Lanza GA, Crea F. Effects of ivabradine and ranolazine in patients with microvascular angina pectoris. Am J Cardiol. 2013;112:8–13.CrossRefPubMed
22.
Zurück zum Zitat Mehta PK, Goykhman P, Thomson LE, Shufelt C, Wei J, Yang Y, Gill E, Minissian M, Shaw LJ, Slomka PJ, Slivka M, Berman DS, Bairey Merz CN. Ranolazine improves angina in women with evidence of myocardial ischemia but no obstructive coronary artery disease. JACC Cardiovasc Imaging. 2011;4:514–22.CrossRefPubMed Mehta PK, Goykhman P, Thomson LE, Shufelt C, Wei J, Yang Y, Gill E, Minissian M, Shaw LJ, Slomka PJ, Slivka M, Berman DS, Bairey Merz CN. Ranolazine improves angina in women with evidence of myocardial ischemia but no obstructive coronary artery disease. JACC Cardiovasc Imaging. 2011;4:514–22.CrossRefPubMed
23.
Zurück zum Zitat Bairey Merz CN, Handberg EM, Shufelt CL, Mehta PK, Minissian MB, Wei J, Thomson LE, Berman DS, Shaw LJ, Petersen JW, Brown GH, Anderson RD, Shuster JJ, Cook-Wiens G, Rogatko A, Pepine CJ. A randomized, placebo-controlled trial of late Na current inhibition (ranolazine) in coronary microvascular dysfunction (CMD): impact on angina and myocardial perfusion reserve. Eur Heart J. 2016;37:1504–13.CrossRefPubMed Bairey Merz CN, Handberg EM, Shufelt CL, Mehta PK, Minissian MB, Wei J, Thomson LE, Berman DS, Shaw LJ, Petersen JW, Brown GH, Anderson RD, Shuster JJ, Cook-Wiens G, Rogatko A, Pepine CJ. A randomized, placebo-controlled trial of late Na current inhibition (ranolazine) in coronary microvascular dysfunction (CMD): impact on angina and myocardial perfusion reserve. Eur Heart J. 2016;37:1504–13.CrossRefPubMed
24.
Zurück zum Zitat Jadhav S, Ferrell W, Greer IA, Petrie JR, Cobbe SM, Sattar N. Effects of metformin on microvascular function and exercise tolerance in women with angina and normal coronary arteries: a randomized, double-blind, placebo-controlled study. J Am Coll Cardiol. 2006;48:956–63.CrossRefPubMed Jadhav S, Ferrell W, Greer IA, Petrie JR, Cobbe SM, Sattar N. Effects of metformin on microvascular function and exercise tolerance in women with angina and normal coronary arteries: a randomized, double-blind, placebo-controlled study. J Am Coll Cardiol. 2006;48:956–63.CrossRefPubMed
25.
Zurück zum Zitat Chen JW, Lee WL, Hsu NW, Lin SJ, Ting CT, Wang SP, Chang MS. Effects of short-term treatment of nicorandil on exercise-induced myocardial ischemia and abnormal cardiac autonomic activity in microvascular angina. Am J Cardiol. 1997;80:32–8.CrossRefPubMed Chen JW, Lee WL, Hsu NW, Lin SJ, Ting CT, Wang SP, Chang MS. Effects of short-term treatment of nicorandil on exercise-induced myocardial ischemia and abnormal cardiac autonomic activity in microvascular angina. Am J Cardiol. 1997;80:32–8.CrossRefPubMed
26.
Zurück zum Zitat Kühl JT, George RT, Mehra VC, Linde JJ, Chen M, Arai AE, Di Carli M, Kitagawa K, Dewey M, Lima JA, Kofoed KF. Endocardial-epicardial distribution of myocardial perfusion reserve assessed by multidetector computed tomography in symptomatic patients without significant coronary artery disease: insights from the CORE320 multicentre study. Eur Heart J Cardiovasc Imaging 2015. Kühl JT, George RT, Mehra VC, Linde JJ, Chen M, Arai AE, Di Carli M, Kitagawa K, Dewey M, Lima JA, Kofoed KF. Endocardial-epicardial distribution of myocardial perfusion reserve assessed by multidetector computed tomography in symptomatic patients without significant coronary artery disease: insights from the CORE320 multicentre study. Eur Heart J Cardiovasc Imaging 2015.
27.
Zurück zum Zitat Reriani M, Raichlin E, Prasad A, Mathew V, Pumper GM, Nelson RE, Lennon R, Rihal C, Lerman LO, Lerman A. Long-term administration of endothelin receptor antagonist improves coronary endothelial function in patients with early atherosclerosis. Circulation. 2010;122:958–66.CrossRefPubMedPubMedCentral Reriani M, Raichlin E, Prasad A, Mathew V, Pumper GM, Nelson RE, Lennon R, Rihal C, Lerman LO, Lerman A. Long-term administration of endothelin receptor antagonist improves coronary endothelial function in patients with early atherosclerosis. Circulation. 2010;122:958–66.CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat Fukumoto Y, Mohri M, Inokuchi K, Ito A, Hirakawa Y, Masumoto A, Hirooka Y, Takeshita A, Shimokawa H. Anti-ischemic effects of fasudil, a specific rho-kinase inhibitor, in patients with stable effort angina. J Cardiovasc Pharmacol. 2007;49:117–21.CrossRefPubMed Fukumoto Y, Mohri M, Inokuchi K, Ito A, Hirakawa Y, Masumoto A, Hirooka Y, Takeshita A, Shimokawa H. Anti-ischemic effects of fasudil, a specific rho-kinase inhibitor, in patients with stable effort angina. J Cardiovasc Pharmacol. 2007;49:117–21.CrossRefPubMed
29.
Zurück zum Zitat Shimokawa H, Sunamura S, Satoh K. RhoA/rho-kinase in the cardiovascular system. Circ Res. 2016;118:352–66.CrossRefPubMed Shimokawa H, Sunamura S, Satoh K. RhoA/rho-kinase in the cardiovascular system. Circ Res. 2016;118:352–66.CrossRefPubMed
30.
Zurück zum Zitat Murthy VL, Naya M, Taqueti VR, Foster CR, Gaber M, Hainer J, Dorbala S, Blankstein R, Rimoldi O, Camici PG, Di Carli MF. Effects of sex on coronary microvascular dysfunction and cardiac outcomes. Circulation. 2014;129:2518–27.CrossRefPubMedPubMedCentral Murthy VL, Naya M, Taqueti VR, Foster CR, Gaber M, Hainer J, Dorbala S, Blankstein R, Rimoldi O, Camici PG, Di Carli MF. Effects of sex on coronary microvascular dysfunction and cardiac outcomes. Circulation. 2014;129:2518–27.CrossRefPubMedPubMedCentral
Metadaten
Titel
Treatment of Angina Pectoris Associated with Coronary Microvascular Dysfunction
verfasst von
Peter Ong
Anastasios Athanasiadis
Udo Sechtem
Publikationsdatum
29.06.2016
Verlag
Springer US
Erschienen in
Cardiovascular Drugs and Therapy / Ausgabe 4/2016
Print ISSN: 0920-3206
Elektronische ISSN: 1573-7241
DOI
https://doi.org/10.1007/s10557-016-6676-z

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