Журнал кардиореспираторных исследований 2026. №1

Maqola mavzusi

SURUNKALI KORONAR SINDROMDA ANTIANGINAL TERAPIYANI KASALLIKNING KLINIK-PATOFIZIOLOGIK FENOTIPLARINI HISOBGA OLGAN HOLDA OPTIMALLASHTIRISH (24-29)

Mualliflar

Tashkenbaeva E.N., Abdulloeva M.D.

Muassasa

Samarqand davlat tibbiyot universiteti

Annotatsiya

Surunkali koronar sindrom (SKS) yurak ishemik kasalligining eng keng tarqalgan va ijtimoiy ahamiyatga ega shakllaridan biri bo‘lib, dunyo miqyosida yurak-qon tomir kasalliklari bilan bog‘liq kasallanish va o‘lim ko‘rsatkichlarining yuqori bo‘lishiga sabab bo‘lmoqda. Miokard revaskulyarizatsiyasi sohasidagi sezilarli yutuqlarga, ikkilamchi profilaktika strategiyalarining takomillashuviga va farmakoterapiya imkoniyatlarining kengayishiga qaramay, bemorlarning muayyan qismida stenokardiya simptomlari saqlanib qolmoqda yoki qaytalanmoqda. Bu holat miokard ishemiyasining patofiziologik mexanizmlarining geterogenligini ko‘rsatadi. Mazkur sharhda SKS zamonaviy nuqtai nazardan dinamik va progressiv jarayon sifatida ko‘rib chiqiladi, u koronar tomirlar aterosklerotik zararlanishining nisbiy klinik barqarorlik va destabilizatsiya bosqichlari bilan tavsiflanadi. Ishemik sindrom shakllanishida koronar mikrotomir disfunktsiyasi, vazospastik reaksiyalar hamda miokard metabolik buzilishlarining roli alohida yoritilgan. Bemorning fenotipik xususiyatlarini hisobga olgan holda tashxis qo‘yish va antianginal terapiyani tanlashda shaxsiylashtirilgan yondashuvni joriy etish zarurligi asoslab berilgan bo‘lib, bu davolash samaradorligini va klinik prognozni yaxshilashga xizmat qiladi.

Kalit so'zlar

Surunkali koronar sindrom, Antianginal terapiya, Miokard ishemiyasi, Koronar mikrotomir disfunktsiyasi, Vazospastik stenokardiya, Shaxsiylashtirilgan tibbiyot, Miokard revaskulyarizatsiyasi.

Adabiyotlar

1. Knuuti J., Wijns W., Saraste A., et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes // European Heart Journal. – 2020. – Vol. 41(3). – P. 407–477. 2. Crea F., Camici P.G., Bairey Merz C.N. Coronary microvascular dysfunction: an update // European Heart Journal. – 2014. – Vol. 35. – P. 1101–1111. 3. Pijls N.H.J., De Bruyne B., Peels K., et al. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses // N Engl J Med. – 2016. – Vol. 334. – P. 1703–1708. 4. Chaitman B.R., Pepine C.J., Parker J.O., et al. Effects of ranolazine with atenolol, amlodipine, or diltiazem on exercise tolerance and angina frequency in patients with chronic angina (CARISA) // JAMA. – 2004. – Vol. 291(3). – P. 309–316. 5. Российское кардиологическое общество. Клинические рекомендации. Хронический коронарный синдром. – М., 2020. 6. Бойцов С.А., Мареев В.Ю. Хронические формы ишемической болезни сердца // Кардиология. – 2019. – Т. 59(6). – С. 5–15. 7. Taqueti V.R., Di Carli M.F. Coronary microvascular disease pathogenic mechanisms and therapeutic options // J Am Coll Cardiol. – 2018. – Vol. 72. – P. 2625–2641. 8. Montalescot G., Sechtem U., Achenbach S., et al. 2013 ESC guidelines on the management of stable coronary artery disease // European Heart Journal. – 2013. – Vol. 34. – P. 2949–3003. 9. Ferrari R., Pavasini R., Camici P.G., et al. Anti-anginal drugs—beliefs and evidence // European Heart Journal. – 2019. – Vol. 40. – P. 190– 194. 10. Мареев В.Ю., Фомин И.В. Хроническая сердечная недостаточность и ишемическая болезнь сердца // Терапевтический архив. – 2020. – Т. 92(9). – С. 4–12. 11. Steg P.G., Greenlaw N., Tendera M., et al. Prevalence of anginal symptoms and myocardial ischemia and their effect on clinical outcomes // JAMA Internal Medicine. – 2014. – Vol. 174. – P. 1651–1659. 12. Бойцов С.А., Мареев В.Ю. Хронические формы ишемической болезни сердца // Кардиология. – 2019. – Т. 59(6). – С. 5–15. 13. Барбараш О.Л., Шляхто Е.В. Современные подходы к лечению хронических форм ИБС // Российский кардиологический журнал. – 2021. – № 26(4). – С. 12–20. 14. Task Force Members. 2024 ESC Guidelines for the management of chronic coronary syndromes // European Heart Journal. – 2024. – Vol. 45. – P. 000–000. 15. Pepine C.J., Ferdinand K.C., Shaw L.J., et al. Emergence of nonobstructive coronary artery disease: a woman’s problem and need for change in definition on angiography // Journal of the American College of Cardiology. – 2015. – Vol. 66(17). – P. 1918–1933. 16. Lanza G.A., De Vita A., Kaski J.C., et al. Current clinical features, diagnostic assessment and prognostic implications of patients with microvascular angina // European Cardiology Review. – 2022. – Vol. 17. – P. e12. 17. Beltrame J.F., Sasayama S., Maseri A. Racial heterogeneity in coronary artery vasomotor reactivity: differences between Japanese and Caucasian patients // Journal of the American College of Cardiology. – 1999. – Vol. 33(6). – P. 1442–1452 18. Шляхто Е.В., Барбараш О.Л., Бойцов С.А. Персонализированная кардиология: современные подходы к стратификации риска и выбору терапии // Российский кардиологический журнал. – 2022. – Т. 27(5). – С. 8–16. 19. Christiaan Vrints, Felicita Andreotti, Konstantinos C Koskinas, Xavier Rossello, Marianna Adamo, James Ainslie, Adrian Paul Banning, Andrzej Budaj, Ronny R Buechel, Giovanni Alfonso Chiariello, Alaide Chieffo, Ruxandra Maria Christodorescu, Christi Deaton, Torsten Doenst, Hywel W Jones, Vijay Kunadian, Julinda Mehilli, Milan Milojevic, Jan J Piek, Francesca Pugliese, Andrea Rubboli, Anne Grete Semb, Roxy Senior, Jurrien M ten Berg, Eric Van Belle, Emeline M Van Craenenbroeck, Rafael Vidal-Perez, Simon Winther, ESC Scientific Document Group , 2024 ESC Guidelines for the management of chronic coronary syndromes: Developed by the task force for the management of chronic coronary syndromes of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS), European Heart Journal, Volume 45, Issue 36, 21 September 2024, Pages 3415–3537, https://doi.org/10.1093/eurheartj/ehae177 20. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines 21. Chaitman BR, Skettino SL, Parker JO, Hanley P, Meluzin J, Kuch J, Pepine CJ, Wang W, Nelson JJ, Hebert DA, Wolff AA; MARISA Investigators. Anti-ischemic effects and long-term survival during ranolazine monotherapy in patients with chronic severe angina. J Am Coll Cardiol. 2004 Apr 21;43(8):1375-82. doi: 10.1016/j.jacc.2003.11.045. PMID: 15093870. 22. Pepine CJ, Wolff AA. A controlled trial with a novel anti-ischemic agent, ranolazine, in chronic stable angina pectoris that is responsive to conventional antianginal agents. Ranolazine Study Group. Am J Cardiol 1999;84:46-50. 23. Morrow DA, Scirica BM, Karwatowska-Prokopczuk E, Murphy SA, Budaj A, Varshavsky S, Wolff AA, Skene A, McCabe CH, Braunwald E; MERLIN-TIMI 36 Trial Investigators. Effects of ranolazine on recurrent cardiovascular events in patients with non-ST-elevation acute coronary syndromes: the MERLIN-TIMI 36 randomized trial. JAMA. 2007 Apr 25;297(16):1775-83. doi: 10.1001/jama.297.16.1775. PMID: 17456819. 24. Mehta, P, Goykhman, P, Thomson, L. et al. Ranolazine Improves Angina in Women With Evidence of Myocardial Ischemia But No Obstructive Coronary Artery Disease. J Am Coll Cardiol Img. 2011 May, 4 (5) 514–522. 25. M.A. Suckow et al. The anti-ischemia agent ranolazine promotes the development of intestinal tumors in APC(min/+) mice. Cancer Letters 209(2004):165–169. 26. Stone P.H., Gratsiansky N.A., Blokhin A. et al. Antianginal and anti-ischemic effects of ranolazine monotherapy in patients with chronic stable angina (MARISA Trial). Journal of the American College of Cardiology. 2006;48:566–575. 27. Wilson S.R., Scirica B.M., Braunwald E. et al. Efficacy of ranolazine in patients with chronic angina receiving amlodipine (ERICA Trial). Journal of the American College of Cardiology. 2007;49:566–575. 28. Jerling M., Abdallah H. Effect of ranolazine on exercise tolerance and angina frequency in patients with chronic angina. American Journal of Cardiology. 2005;96:15–20. 29. Bairey Merz C.N., Handberg E.M., Shufelt C.L. et al. A randomized, placebo-controlled trial of late Na current inhibition (ranolazine) in coronary microvascular dysfunction. European Heart Journal. 2016;37:1504–1513. 30. Safdar B., D’Onofrio G., Dziura J. et al. Ranolazine and coronary flow reserve in patients with angina and non-obstructive coronary artery disease. Clinical Therapeutics. 2017;39:456–466. 31. Kofler T., Hess S., Moccetti F. et al. Efficacy of ranolazine for treatment of coronary microvascular dysfunction: systematic review and meta-analysis of randomized trials. CJC Open. 2020;2:507–514. 32. Taqueti V.R., Di Carli M.F. Coronary microvascular disease pathogenesis and clinical implications. Circulation. 2018;138:146–159. 33. Ford T.J., Berry C. How to diagnose and manage angina without obstructive coronary artery disease: lessons from the CORMICA trial. Interventional Cardiology Review. 2019;14:76–82. 34. Ling H., et al. Ranolazine for improving coronary microvascular function in patients with non-obstructive coronary artery disease. Quantitative Imaging in Medicine and Surgery. 2024;14:1162–1174. 35. Beltrame J.F., Crea F., Kaski J.C. et al. Coronary microvascular dysfunction. European Heart Journal. 2017;38:473–488. 36. Ong P., Camici P.G., Beltrame J.F. et al. International standardization of diagnostic criteria for microvascular angina. European Heart Journal. 2018;39:1101–1111. 37. De Bruyne B., Pijls N.H.J., Kalesan B. et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. New England Journal of Medicine. 2012;367:991–1001. 38. Davies J.E., Sen S., Dehbi H.M. et al. Use of the instantaneous wave-free ratio (iFR) in the assessment of coronary stenosis. New England Journal of Medicine. 2017;376:1824–1834. 39. Crea F., Lanza G.A., Camici P.G. Mechanisms of coronary microvascular dysfunction and ischemia with non-obstructive coronary arteries (INOCA). European Heart Journal. 2014;35:1101–1111. 40. Knuuti J., Wijns W., Saraste A. et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. European Heart Journal. 2020;41:407–477. 41. ACC/AHA Joint Committee. 2023 ACC/AHA Guideline for the management of chronic coronary disease. Circulation. 2023. 42. Ministry of Health of the Republic of Uzbekistan. National clinical protocol for diagnosis and treatment of stable angina. Tashkent; 2022.