Total ischemic burden: definition, mechanisms, and therapeutic implications

Area of Science:

• Cardiology
• Ischemic Heart Disease Pathophysiology

Background:

• The total ischemic burden encompasses all ischemic episodes, both silent and symptomatic.
• This broadens the understanding of ischemia beyond symptomatic events in coronary heart disease (CHD).

Purpose of the Study:

• To re-evaluate current therapeutic goals for patients with coronary heart disease based on the total ischemic burden.
• To explore the pathophysiologic mechanisms of ischemia, including supply-demand imbalances.

Main Methods:

• Conceptual review of ischemia and its implications for CHD therapy.
• Analysis of pathophysiologic mechanisms: primary (reduced supply), secondary (increased demand), and mixed ischemia.

Main Results:

• Ischemia can result from reduced supply, increased demand, or both.
• Vasoconstriction appears to play a role in supply/demand imbalance, especially during everyday activities, indicated by lower heart rates during ischemic episodes.

Conclusions:

• The concept of total ischemic burden necessitates a re-evaluation of therapeutic strategies in CHD.
• Calcium antagonists show promise for treating angina by targeting vasoconstriction and improving the supply/demand balance.