Coronary microcirculation in acute myocardial ischaemia: From non-invasive to invasive absolute flow assessment

Area of Science:

• Cardiology
• Cardiovascular Research
• Medical Diagnostics

Background:

• Ischaemic heart disease, including acute coronary syndrome, persists as a primary global mortality cause despite advances in revascularization.
• Detecting and managing extended myocardial damage post-revascularization remains a significant clinical challenge.
• Current indices for evaluating myocardial damage and recovery are categorized as non-invasive or invasive, aiding risk stratification and treatment tailoring.

Purpose of the Study:

• To review non-invasive and invasive indices for assessing coronary microcirculation.
• To evaluate the predictive capability of these indices for clinical outcomes.
• To discuss therapeutics aimed at reducing microvascular damage and improving outcomes.

Main Methods:

• Comprehensive literature review of non-invasive and invasive indices for microcirculation assessment.
• Analysis of the prognostic value of these indices in predicting clinical impact.
• Survey of current therapeutic strategies targeting microvascular dysfunction.

Main Results:

• Numerous indices exist to evaluate myocardial damage, infarct size, and recovery potential.
• Indices are broadly classified into non-invasive (post-revascularization) and invasive (during revascularization) methods.
• Challenges remain in utilizing these indices for evaluating new therapeutics and understanding the "black box" of microcirculation.

Conclusions:

• Effective assessment of microcirculation is crucial for understanding and managing ischaemic heart disease.
• Indices of microcirculation can predict clinical impact and guide therapeutic decisions.
• Further research into dedicated therapeutics is needed to mitigate microvascular damage and improve patient outcomes.