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<p>Coronary heart disease is characterized by structural and functional alterations of the coronary arteries. The structural alterations of the epicardial coronary arteries are well known and the diagnostics and treatment are well established. In contrast, functional alterations of the coronary arteries or structural alterations of the coronary microcirculation are more difficult to diagnose. The relevant diseases in this area (i.e., coronary microvascular dysfunction, CMD and vasospastic angina, VSA) have steadily gained interest. They are caused by different pathophysiological mechanisms, which lead to a disrupted regulation of epicardial and microvascular vasotonus. In patients with pectanginous symptoms without obstructive coronary heart disease (CHD) studies have shown a&#xa0;high prevalence of CMD and VSA (up to 90% depending on the patient collective). Nevertheless, the appropriate diagnostics in Germany have so far only been established in a&#xa0;few specialized centers. There is therefore a&#xa0;clear need for a standardization of the protocols on invasive investigations of coronary vasomotion disorders to facilitate the distribution of these diagnostic methods. Although the diagnostic criteria and the importance of these investigations, a&#xa0;class I recommendation in the guidelines of the European Society for Cardiology on chronic coronary syndrome since 2024, has been emphasized many times, the implementation in the clinical practice is currently insufficient. In addition, in the German-speaking area a&#xa0;position paper is lacking that systematically defines the procedure and diagnostic criteria for these syndromes.</p>

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Empfehlung zur invasiven Untersuchung der mikrovaskulären Dysfunktion und des Koronarspasmus – DGK-Positionspapier

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月21日

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  • Peter Ong,
  • Julia Christina Lueg,
  • Matthias Lutz,
  • Alexander Ghanem,
  • Maike Knorr,
  • Ralf Birkemeyer,
  • Tanja Katharina Rudolph,
  • Tommaso Gori

摘要

Coronary heart disease is characterized by structural and functional alterations of the coronary arteries. The structural alterations of the epicardial coronary arteries are well known and the diagnostics and treatment are well established. In contrast, functional alterations of the coronary arteries or structural alterations of the coronary microcirculation are more difficult to diagnose. The relevant diseases in this area (i.e., coronary microvascular dysfunction, CMD and vasospastic angina, VSA) have steadily gained interest. They are caused by different pathophysiological mechanisms, which lead to a disrupted regulation of epicardial and microvascular vasotonus. In patients with pectanginous symptoms without obstructive coronary heart disease (CHD) studies have shown a high prevalence of CMD and VSA (up to 90% depending on the patient collective). Nevertheless, the appropriate diagnostics in Germany have so far only been established in a few specialized centers. There is therefore a clear need for a standardization of the protocols on invasive investigations of coronary vasomotion disorders to facilitate the distribution of these diagnostic methods. Although the diagnostic criteria and the importance of these investigations, a class I recommendation in the guidelines of the European Society for Cardiology on chronic coronary syndrome since 2024, has been emphasized many times, the implementation in the clinical practice is currently insufficient. In addition, in the German-speaking area a position paper is lacking that systematically defines the procedure and diagnostic criteria for these syndromes.