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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.

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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.