Coronary Microcirculatory Dysfunction in Human Cardiomyopathies: A Pathologic and Pathophysiologic Review
Kristina Selthofer-Relatic1, Martina Mihalj, Aleksandar Kibel
1From the *Department for Cardiovascular Diseases, Osijek University Hospital, Osijek, Croatia; †Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; ‡Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; §Department of Pathophysiology, Semmelweis University, Budapest, Hungary; ¶Institute of Natural Sciences, University of Physical Education, Budapest, Hungary; and ‖Department of Physiology, New York Medical College, Valhalla, NY.
Insights
Cardiomyopathies are diverse heart muscle diseases affecting cardiomyocytes and coronary circulation. This review explores their pathological features and underlying mechanisms, highlighting challenges in diagnosis and therapy.
Area of Science:
- Cardiology
- Pathophysiology
- Vascular Biology
Background:
- Cardiomyopathies encompass heterogeneous myocardial diseases with complex pathogenic mechanisms.
- These diseases impact cardiomyocytes, extravascular tissues, and coronary vasculature, leading to symptoms like dyspnea and arrhythmias.
- Diagnosis and therapy remain challenging due to the heterogeneity of cardiomyopathic patterns and symptoms.
Purpose of the Study:
- To summarize common pathological features and adaptations of coronary microcirculation in various cardiomyopathies.
- To integrate current understanding of pathophysiological mechanisms underlying cardiomyopathy development.
- To highlight the role of microvascular dysfunction in cardiac dysfunction and disease outcomes.
Main Methods:
- Review of existing literature on cardiomyopathies and coronary microcirculation.
- Analysis of pathological characteristics and adaptations in different cardiomyopathy types.
- Integration of genetic, immunologic, systemic, comorbidity, aging, and fibrosis factors.
Main Results:
- Cardiomyopathies involve progressive changes in cardiomyocytes and coronary microcirculation.
- Key contributing factors include genetic-immunologic-systemic factors, comorbidities, aging-induced arteriosclerosis, and myocardial fibrosis.
- Microvascular dysfunction is consistently present, contributing to cardiac dysfunction and prognosis.
Conclusions:
- Understanding the interplay between myocardial abnormalities and coronary circulation is crucial but still incomplete.
- Current therapeutic strategies lack specificity for different cardiomyopathy types, despite the recognized role of microvascular dysfunction.
- Further research is needed to develop targeted therapies addressing microvascular dysfunction in cardiomyopathies.
Abstract:
Cardiomyopathies are a heterogeneous group of diseases of the myocardium. The term cardiomyopathy involves a wide range of pathogenic mechanisms that affect the structural and functional states of cardiomyocytes, extravascular tissues, and coronary vasculature, including both epicardial coronary arteries and the microcirculation. In the developed phase, cardiomyopathies present with various clinical symptoms: dyspnea, chest pain, palpitations, swelling of the extremities, arrhythmias, and sudden cardiac death. Due to the heterogeneity of cardiomyopathic patterns and symptoms, their diagnosis and therapies are great challenges. Despite extensive research, the relation between the structural and functional abnormalities of the myocardium and the coronary circulation are still not well understood in the various forms of cardiomyopathy. The main pathological characteristics of cardiomyopathies and the coronary microcirculation develop in a progressive manner due to (1) genetic-immunologic-systemic factors; (2) comorbidities with endothelial, myogenic, metabolic, and inflammatory changes; (3) aging-induced arteriosclerosis; and (4) myocardial fibrosis. The aim of this review is to summarize the most important common pathological features and/or adaptations of the coronary microcirculation in various types of cardiomyopathies and to integrate the present understanding of the underlying pathophysiological mechanisms responsible for the development of various types of cardiomyopathies. Although microvascular dysfunction is present and contributes to cardiac dysfunction and the potential outcome of disease, the current therapeutic approaches are not specific for the given types of cardiomyopathy.
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