Ischaemia without obstructive coronary artery disease: the pathophysiology of microvascular dysfunction
| Autor: | Divaka Perera, Haseeb Rahman, Aish Sinha |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Ischemia Coronary Artery Disease 030204 cardiovascular system & hematology Coronary Angiography Microcirculation Coronary artery disease Angina 03 medical and health sciences Coronary circulation 0302 clinical medicine Coronary Circulation Internal medicine medicine Humans 030212 general & internal medicine business.industry medicine.disease Coronary Vessels Pathophysiology Coronary arteries medicine.anatomical_structure Quality of Life Vascular resistance Cardiology Cardiology and Cardiovascular Medicine business |
| Zdroj: | Current Opinion in Cardiology. 35:720-725 |
| ISSN: | 1531-7080 0268-4705 |
| Popis: | Purpose of review Nearly one-third of patients presenting with angina have unobstructed epicardial coronary arteries and evidence of coronary microvascular disease. Up until recently, the pathophysiology of coronary microvascular disease has been poorly understood, resulting in limited effective therapeutic options in these patients. As a result, patients with coronary microvascular disease continue to suffer from a poor quality of life and adverse cardiovascular outcomes. Recent findings Recent mechanistic studies have improved our understanding of the pathophysiology underlying coronary microvascular dysfunction; these studies have implicated the nitric oxide and endothelin pathways as the main drivers. The aim of this article is to review our current understanding of the pathophysiology of ischaemia in patients with coronary microvascular disease. Summary Patients with angina who have coronary microvascular disease, but no obstructive coronary artery disease, are unable to augment their coronary blood flow in response to physiological stress, thereby predisposing them to myocardial ischaemia as a result of supply:demand mismatch in the myocardium. In addition to abnormalities of vascular resistance, perturbations in cardiac-coronary coupling also contribute to ischaemia in these patients. Although impaired flow reserve is the diagnostic hallmark, mechanistic studies have demonstrated that the underlying pathophysiology is heterogeneous. At present, two main endotypes have been identified, which can be readily differentiated on the basis of minimal microvascular resistance. A better understanding of the pathophysiology and mechanisms driving ischaemia in coronary microvascular dysfunction may stimulate the development of individualised therapies that may lead to an improvement in patients' quality of life and prognosis. |
| Databáze: | OpenAIRE |
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