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Coronary microvascular dysfunction due to Chagas disease: where are we now?

Denise Mayumi Tanaka1, Marcus Vinícius Simões1, José Antônio Marin-Neto1

  • 1Medical School of Ribeirao Preto, University of São Paulo, Sao Paulo, Brazil.

Expert Review of Cardiovascular Therapy
|May 18, 2023
PubMed

Insights

Myocardial ischemia in chronic Chagas cardiomyopathy (CCC) is driven by microvascular dysfunction, not epicardial disease. Targeting this microvascular impairment may slow disease progression and improve patient outcomes.

Area of Science:

  • Cardiology
  • Pathophysiology
  • Medical Science

Background:

  • Myocardial ischemia is prevalent in chronic Chagas cardiomyopathy (CCC).
  • Recent studies reveal microvascular abnormalities contribute significantly to myocardial damage progression in CCC.
  • These microvascular derangements occur early and lead to myocardial dysfunction.

Purpose of the Study:

  • To summarize the role of coronary microvascular dysfunction in causing myocardial ischemia in CCC.
  • To review the implications for clinical management of CCC patients.
  • To highlight recent therapeutic strategies targeting microvascular dysfunction.

Main Methods:

  • Extensive review of the scientific literature on CCC and myocardial ischemia.
  • Analysis of clinical and experimental studies focusing on microvascular function.
  • Synthesis of findings regarding pathophysiology and therapeutic interventions.

Main Results:

  • Consistently reported functional and structural microvascular abnormalities in CCC, independent of obstructive epicardial coronary artery disease.
  • Preclinical studies demonstrate a correlation between perfusion defects, inflammation, and myocardial dysfunction in CCC.
  • Microvascular dysfunction is an early event contributing to CCC progression.

Conclusions:

  • Coronary microvascular dysfunction is a key factor in myocardial ischemia in CCC.
  • Reversing microvascular dysfunction is a promising therapeutic target for CCC.
  • Further research is needed to evaluate novel interventions for microvascular ischemia, inflammation, and ventricular dysfunction in CCC.
Abstract

Keywords:
Chagas diseaseChagas heart diseasechest paincoronary microvascular dysfunctionventricular dysfunction

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