Coronary Microvascular Dysfunction Across the Spectrum of Cardiovascular Diseases JACC State-of-the-Art Review

被引:411
作者
Del Buono, Marco Giuseppe [1 ]
Montone, Rocco A. [2 ]
Camilli, Massimiliano [1 ]
Carbone, Salvatore [3 ,4 ]
Narula, Jagat [5 ]
Lavie, Carl J. [6 ]
Niccoli, Giampaolo [7 ]
Crea, Filippo [1 ,2 ]
机构
[1] Catholic Univ, Dept Cardiovasc & Pulm Sci, Sacred Heart, Rome, Italy
[2] Fondazione Policlinico Univ Gemelli IRCCS, Dept Cardiovasc Med, Rome, Italy
[3] Virginia Commonwealth Univ, Coll Human & Sci, Dept Kinesiol & Hlth Sci, Richmond, VA USA
[4] Virginia Commonwealth Univ, Div Cardiol, Dept Internal Med, VCU Pauley Heart Ctr, Richmond, VA USA
[5] Icahn Sch Med Mt Sinai, New York, NY USA
[6] Ochsner Clin Sch, Dept Cardiovasc Dis, New Orleans, LA USA
[7] Univ Parma, Dept Med, Parma, Italy
基金
美国国家卫生研究院;
关键词
KEY WORDS angina; coronary flow reserve; coronary microvascular dysfunction; coronary spasm; microvascular angina; heart failure; HFpEF; INOCA; ischemia; ischemic heart disease; microcirculation; MINOCA; provocative testing; ACKNOWLEDGMENT The authors thank Dr A; M; Leone for his help in preparing Figure 3; PRESERVED EJECTION FRACTION; CONVERTING ENZYME-INHIBITION; MYOCARDIAL BLOOD-FLOW; AORTIC-VALVE STENOSIS; HEART-FAILURE; DILATED CARDIOMYOPATHY; EXERCISE INTOLERANCE; VELOCITY RESERVE; PROGNOSTIC VALUE; ANGINA-PECTORIS;
D O I
10.1016/j.jacc.2021.07.042
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Coronary microvascular dysfunction (CMD) encompasses several pathogenetic mechanisms involving coronary micro-circulation and plays a major role in determining myocardial ischemia in patients with angina without obstructive coronary artery disease, as well as in several other conditions, including obstructive coronary artery disease, nonischemic car-diomyopathies, takotsubo syndrome, and heart failure, especially the phenotype associated with preserved ejection fraction. Unfortunately, despite the identified pathophysiological and prognostic role of CMD in several conditions, to date, there is no specific treatment for CMD. Due to the emerging role of CMD as common denominator in different clinical phenotypes, additional research in this area is warranted to provide personalized treatments in this "garden variety" of patients. The purpose of this review is to describe the pathophysiological mechanisms of CMD and its mechanistic and prognostic role across different cardiovascular diseases. We will also discuss diagnostic modalities and the potential therapeutic strategies resulting from recent clinical studies. (J Am Coll Cardiol 2021;78:1352-1371) (c) 2021 by the American College of Cardiology Foundation.
引用
收藏
页码:1352 / 1371
页数:20
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