Targeting the dominant mechanism of coronary microvascular dysfunction with intracoronary physiology tests

The International Journal of Cardiovascular Imaging
Hernán Mejía-RenteríaJavier Escaned

Abstract

The coronary microcirculation plays a key role in modulating blood supply to the myocardium. Several factors like myocardial oxygen demands, endothelial and neurogenic conditions determine its function. Although there is available evidence supporting microvascular dysfunction as an important cause of myocardial ischaemia, with both prognostic and symptomatic implications, its diagnosis and management in clinical practice is still relegated to a second plane. Both diagnostic and therapeutic approaches are hampered by the broadness of the concept of microvascular dysfunction, which fails addressing the plurality of mechanisms leading to dysfunction. Normal microcirculatory function requires both structural integrity of the microcirculatory vascular network and preserved signalling pathways ensuring adequate and brisk arteriolar resistance shifts in response to myocardial oxygen demands. Pathological mechanisms affecting these requirements include structural remodelling of microvessels, intraluminal plugging, extravascular compression or vasomotor dysregulation. Importantly, not every diagnostic technique provides evidence on which of these pathophysiological mechanisms is present or predominates in the microcirculation. In this p...Continue Reading

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Citations

Jun 18, 2017·The International Journal of Cardiovascular Imaging·Shengxian TuWilliam Wijns
Apr 25, 2018·Minerva cardioangiologica·Hernán Mejía-RenteríaJavier Escaned
Jul 2, 2020·European Heart Journal·Javier Escaned, Lilach O Lerman
Apr 14, 2018·The International Journal of Cardiovascular Imaging·Johan H C ReiberNico R L Van de Veire
Sep 11, 2019·European Heart Journal·Juhani KnuutiUNKNOWN ESC Scientific Document Group
Sep 10, 2020·Journal of Clinical Medicine·Federico VancheriMichael Henein
Jul 7, 2020·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Vijay KunadianAndreas Baumbach
Dec 16, 2018·Biomedicine & Pharmacotherapy = Biomédecine & Pharmacothérapie·Wenjing LiaoHe Sun
Jul 27, 2020·JACC. Cardiovascular Interventions·Norihiro KogamePatrick W Serruys
Sep 1, 2021·Trends in Cardiovascular Medicine·Mikhail S Dzeshka
Dec 24, 2021·European Journal of Clinical Investigation·George Markousis-MavrogenisSophie I Mavrogeni

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