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Pathophysiology and Outcomes of Endothelium Function in Coronary Microvascular Diseases: A Systematic Review of
Sanjeet Singh Avtaar Singh1, Francesco Nappi2
1Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
Insights
Coronary microvascular dysfunction (CMD) is underappreciated, highlighting the importance of medical therapy for outcomes. Further research is exploring therapeutic agents for secondary prevention in cardiovascular disease.
Area of Science:
- Cardiology
- Vascular Biology
- Medical Research
Background:
- Coronary artery bypass grafting (CABG) vs. Percutaneous Coronary Intervention (PCI) debates continue, with trials like ISCHEMIA and ORBITA showing no clear superiority of invasive over conservative management for clinical endpoints or angina relief.
- Existing research has not definitively proven the benefit of PCI over optimal medical therapy (OMT).
- This review focuses on factors contributing to endothelial dysfunction, drawing from recent randomized clinical trials and multicenter studies.
Purpose of the Study:
- To review the role of various factors contributing to endothelial dysfunction.
- To synthesize findings from recent randomized clinical trials and multicenter studies on endothelial dysfunction.
- To underscore the significance of coronary microvascular dysfunction (CMD) in cardiovascular outcomes.
Main Methods:
- A comprehensive search strategy was employed using a previously published dataset.
- Pooled analysis included research articles, CABG, and PCI randomized controlled trials (RCTs) in human and animal models.
- Detailed methods for the search strategy and data pooling have been previously published and registered.
Main Results:
- Nitric oxide (NO), EDCFs, vasodilator prostaglandins, and EDH factors are vital for maintaining coronary vasomotor tone.
- Homeostatic mechanisms are influenced by shear forces and emerging factors like vaping.
- Intracoronary testing is crucial for evaluating therapeutic medication effects, with ongoing studies planned.
Conclusions:
- The impact of coronary microvascular dysfunction (CMD) may be underestimated, emphasizing the role of medical therapy in patient outcomes.
- Ongoing clinical trials are investigating the efficacy of therapeutic agents in secondary cardiovascular prevention.
Background:
Coronary macrovascular disease is a concept that has been well-studied within the literature and has long been the subject of debates surrounding coronary artery bypass grafting (CABG) vs. Percutaneous Coronary Intervention (PCI). ISCHEMIA trial reported no statistical difference in the primary clinical endpoint between initial invasive management and initial conservative management, while in the ORBITA trial PCI did not improve angina frequency score significantly more than placebo, albeit PCI resulted in more patient-reported freedom from angina than placebo. However, these results did not prove the superiority of the PCI against OMT, therefore do not indicate the benefit of PCI vs. the OMT. Please rephrase the sentence. We reviewed the role of different factors responsible for endothelial dysfunction from recent randomized clinical trials (RCTs) and multicentre studies.
Methods:
A detailed search strategy was performed using a dataset that has previously been published. Data of pooled analysis include research articles (human and animal models), CABG, and PCI randomized controlled trials (RCTs). Details of the search strategy and the methods used for data pooling have been published previously and registered with Open-Source Framework.
Results:
The roles of nitric oxide (NO), endothelium-derived contracting factors (EDCFs), and vasodilator prostaglandins (e.g., prostacyclin), as well as endothelium-dependent hyperpolarization (EDH) factors, are crucial for the maintenance of vasomotor tone within the coronary vasculature. These homeostatic mechanisms are affected by sheer forces and other several factors that are currently being studied, such as vaping. The role of intracoronary testing is crucial when determining the effects of therapeutic medications with further studies on the horizon.
Conclusion:
The true impact of coronary microvascular dysfunction (CMD) is perhaps underappreciated, which supports the role of medical therapy in determining outcomes. Ongoing trials are underway to further investigate the role of therapeutic agents in secondary prevention.
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