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Endothelial Dysfunction and Coronary Vasoreactivity - A Review of the History, Physiology, Diagnostic Techniques, and

Tharusha Gunawardena1, Ioannis Merinopoulos1, Upul Wickramarachchi1

  • 1Department of Cardiology, Norfolk and Norwich University Hospital, Colney Lane NR4 7UY, Norwich, United Kingdom.

Current Cardiology Reviews
|June 20, 2020
PubMed

Insights

Percutaneous coronary intervention advances treatment for coronary artery disease but often overlooks the microcirculation. Greater focus on coronary endothelium and microcirculation mechanisms can improve revascularization strategies.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Interventional Cardiology

Background:

  • Percutaneous coronary intervention (PCI) has transformed coronary artery disease (CAD) treatment by focusing on major epicardial arteries.
  • Current PCI strategies, despite evolving physiological assessments, frequently neglect the crucial role of the coronary microcirculation in patient prognosis.
  • The coronary microcirculation, often viewed as a simple conduit, possesses significant functional importance and influences cardiovascular outcomes.

Purpose of the Study:

  • To review the organization and physiology of the coronary circulation, highlighting its functional significance.
  • To examine current diagnostic methods and techniques for assessing the coronary microcirculation.
  • To discuss the impact of PCI on coronary artery endothelial function and the long-term consequences for the coronary microcirculation.

Main Methods:

  • Literature review of studies on coronary circulation organization, physiology, and assessment techniques.
  • Analysis of research on coronary artery endothelial function and the effects of PCI.
  • Exploration of the spectrum of coronary artery disease and its microcirculatory implications.

Main Results:

  • The coronary circulation is an organ with functional significance beyond mere blood conduction.
  • PCI can have latent effects on the coronary microcirculation, leading to long-term consequences.
  • Coronary artery disease involves a spectrum of disorders where microcirculatory dysfunction plays a key role.

Conclusions:

  • Enhanced understanding of the coronary artery endothelium and microcirculation mechanisms is essential.
  • Integrating microcirculatory assessment into PCI decision-making can optimize revascularization strategies.
  • Future research should focus on the functional role of the coronary microcirculation in CAD management.

Keywords:
Drug coated balloonsMINOCAacute coronary syndromeanginabioresorbable scaffoldscoronary microcirculationdrug eluting stentsendothelial functionmicrovascular anginavasomotionvasoreactivity testing

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