Innervation of the coronary arteries and its role in controlling microvascular resistance

Area of Science:

• Cardiovascular Physiology
• Neurocardiology

Background:

• Coronary circulation balances myocardial oxygen supply and demand, regulated by perfusion pressure, extravascular forces, and microvascular resistance.
• Autoregulation of coronary blood flow involves complex mechanical, endothelial, metabolic, neural, and hormonal interactions.
• Neural mechanisms are critical but poorly understood in human coronary arteries due to species variability.

Purpose of the Study:

• To review the neural mechanisms governing human coronary artery innervation and microvascular resistance.
• To emphasize the clinical relevance of understanding neural control in ischemia with non-obstructive coronary arteries.
• To highlight the need for further research on human coronary artery innervation.

Main Methods:

• Review of existing literature on coronary arterial innervation, focusing on animal models and limited human data.
• Discussion of the role of neural control in microvascular dysfunction and autoregulation.
• Analysis of clinical implications, including diagnostic approaches and therapeutic strategies.

Main Results:

• Coronary arterial innervation is highly variable across species, limiting direct translation of animal findings to humans.
• Microvascular dysfunction, characterized by abnormal vasoconstriction/vasodilation, is central to ischemia with non-obstructive coronary arteries.
• Neural mechanisms are implicated in microvascular resistance and symptom control in angina.

Conclusions:

• Understanding human coronary artery innervation is crucial for cardiologists to diagnose and manage microvascular dysfunction.
• Neural control of microvascular resistance is a key factor in preventing myocardial ischemia.
• Further research into human coronary innervation can drive innovations in diagnosing and treating coronary artery diseases.