Coronary microvascular dysfunction, arrythmias, and sudden cardiac death: A literature review

Area of Science:

• Cardiology
• Vascular Biology
• Cardiac Electrophysiology

Background:

• The coronary vascular system's structure adapts to myocardial demand, with a network from epicardial arteries to microcirculation.
• Myocardial ischemia, resulting from unmet demand, leads to angina and adverse outcomes.
• Coronary microvascular dysfunction (CMD) is prevalent, affecting 66% of angina patients with non-obstructive coronary disease.

Purpose of the Study:

• To elucidate the impact of CMD on cardiac function and patient outcomes.
• To explore the association between CMD and conditions like atrial fibrillation and ventricular repolarization abnormalities.
• To identify the underlying pathogenesis of CMD.

Main Methods:

• Analysis of existing literature and patient data concerning coronary microvascular function.
• Review of studies linking CMD to atrial fibrillation and ventricular electrical properties.
• Examination of etiological factors including oxidative stress and structural changes.

Main Results:

• CMD is independently associated with atrial fibrillation and increased ventricular electrical inhomogeneity.
• CMD contributes to the progression of cardiac disease and increases mortality risk.
• Pathogenesis involves oxidative stress, impaired vasoactivity, and structural disorders like fibrosis.

Conclusions:

• CMD significantly impacts atrial and ventricular function, increasing risks for arrhythmias and sudden cardiac arrest.
• Distorted ventricular repolarization parameters (e.g., QT dispersion) in CMD can promote ventricular arrhythmias.
• CMD represents a critical, independent risk factor for adverse cardiovascular events and mortality.