[Dysfunction of vascular endothelium in patients with coronary heart disease]

Area of Science:

• Cardiology
• Vascular Physiology
• Internal Medicine

Background:

• Coronary heart disease (CHD) with angina of effort presents varied vascular responses.
• Understanding these responses is crucial for effective patient management.
• Classifying patients based on vascular reactivity can reveal underlying pathophysiological differences.

Purpose of the Study:

• To categorize patients with FC II-IV CHD and angina based on their vascular reaction to ischemic load.
• To identify specific predictors associated with each type of vascular response.
• To elucidate the mechanisms (hydrodynamic vs. metabolic) driving these distinct vascular reactions.

Main Methods:

• Patients with FC II-IV CHD and angina were divided into compensated, subcompensated, and decompensated groups.
• Vascular reaction was assessed using local ischemic load.
• Serum lipid spectrum, hemostasis parameters, and blood flow were evaluated pre- and post-ischemia.

Main Results:

• Each vascular reaction type exhibited unique predictors.
• Vasodilation in 'compensated' patients was primarily driven by hydrodynamic vascular bed changes.
• The 'subcompensated' group showed reduced sensitivity to hydrodynamic changes.
• The 'decompensated' group displayed paradoxical vasoconstriction, linked to metabolic rather than hydrodynamic disorders.

Conclusions:

• Vascular reactivity in CHD patients with angina is heterogeneous.
• Compensated responses are mainly hydrodynamic, while decompensated responses involve metabolic dysregulation.
• Identifying these distinct vascular reaction types offers insights into disease mechanisms and potential therapeutic targets.