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Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
Published on: August 17, 2022
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Coronary "Microvascular Dysfunction": Evolving Understanding of Pathophysiology, Clinical Implications, and Potential
Chun Yeung Kei1, Kuljit Singh2,3, Rustem F Dautov4,5
1Department of Medicine, University of Adelaide, Adelaide 5371, Australia.
International Journal of Molecular Sciences
|July 29, 2023
Summary
Stable angina and heart attacks may stem from small vessel issues, not just blockages. Inflammation and microvascular dysfunction, impacting blood flow and clotting, are key factors challenging traditional views.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Pathophysiology
Background:
- Traditional view: Stable angina pectoris (SAP) and acute myocardial infarction (AMI) linked to epicardial coronary artery stenoses and plaque rupture.
- Recent trials (ORBITA, ISCHEMIA) show limited benefit of angioplasty/stenting for SAP symptoms and AMI prevention.
- This necessitates a shift in focus towards coronary microvascular anomalies.
Purpose of the Study:
- To explore the role of coronary microvasculature dysfunction in cardiovascular disorders.
- To understand the mechanisms underlying microvascular abnormalities.
- To highlight the need for novel therapeutic strategies targeting small coronary vessels.
Main Methods:
- Review of recent studies on coronary microvasculature structure and function.
- Analysis of inflammatory pathways (mast cells, platelets, neutrophils) and endothelial glycocalyx.
- Examination of physiological dysfunction, including impaired vasodilation and microthrombus formation.
Main Results:
- Coronary microvasculature is frequently abnormal structurally and physiologically, independent of epicardial stenoses.
- Inflammation-induced structural remodeling, including glycocalyx shedding, disrupts laminar flow and promotes platelet interaction.
- Physiological dysfunction involves impaired responsiveness to vasodilators, leading to vasoconstriction and microthrombus propensity.
Conclusions:
- Microvascular dysfunction is a critical factor in myocardial ischemia and various cardiovascular conditions.
- Glycocalyx shedding plays a significant role in coronary artery spasm, aging, AMI, and vasculitis.
- New therapeutic approaches targeting the coronary microvasculature are essential for managing SAP and other cardiovascular diseases.
Keywords:
coronary microvesselsglycocalyxmast cellsplatelet aggregationstable angina pectorisvascular ageingvasodilator autacoidsMore Related Videos
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