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Coronary microvascular dysfunction in the clinical setting: from mystery to reality

Herrmann, J; Kaski, JC; Lerman, A (2012) Coronary microvascular dysfunction in the clinical setting: from mystery to reality. EUROPEAN HEART JOURNAL, 33 (22). 2771 - U39 (13). ISSN 0195-668X https://doi.org/10.1093/eurheartj/ehs246
SGUL Authors: Kaski, Juan Carlos

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Abstract

Far more extensive than the epicardial coronary vasculature that can be visualized angiographically is the coronary microcirculation, which foregoes routine imaging. Probably due to the lack of techniques able to provide tangible evidence of its crucial role, the clinical importance of coronary microvascular dysfunction is not fully appreciated. However, evidence gathered over the last several decades indicates that both functional and structural abnormalities of the coronary microvasculature can lead to myocardial ischaemia, often comparable with that caused by obstructive coronary artery disease. Indeed, a marked increase in coronary microvascular resistance can impair coronary blood flow and trigger angina pectoris, ischaemic ECG shifts, and myocardial perfusion defects, and lead to left ventricular dysfunction in patients who otherwise have patent epicardial coronary arteries. This condition—often referred to as ‘chest pain with normal coronary arteries’ or ‘cardiac syndrome X’—encompasses several pathogenic mechanisms involving the coronary microcirculation. Of importance, coronary microvascular dysfunction can occur in conjunction with several other cardiac disease processes. In this article, we review the pathogenic mechanisms leading to coronary microvascular dysfunction and its diagnostic assessment, as well as the different clinical presentations and prognostic implications of microvascular angina. As such, this review aims to remove at least some of the mystery surrounding the notion of coronary microvascular dysfunction and to show why it represents a true clinical entity.

Item Type: Article
Additional Information: PubMed ID: 22915165
Keywords: Acute Coronary Syndrome, Cardiac Imaging Techniques, Cardiomyopathies, Chronic Disease, Heart Failure, Hemodynamics, Humans, Microcirculation, Microvascular Angina, Myocardial Infarction, Percutaneous Coronary Intervention, Prognosis, Science & Technology, Life Sciences & Biomedicine, Cardiac & Cardiovascular Systems, Cardiovascular System & Cardiology, CARDIAC & CARDIOVASCULAR SYSTEMS, Cardiac syndrome X, Coronary flow reserve, Microvascular angina, Prognosis, ACUTE MYOCARDIAL-INFARCTION, LEFT-VENTRICULAR DYSFUNCTION, POSITRON-EMISSION-TOMOGRAPHY, STABLE ANGINA-PECTORIS, CARDIAC SYNDROME-X, ISCHEMIA SYNDROME EVALUATION, TAKO-TSUBO CARDIOMYOPATHY, AORTIC-VALVE-REPLACEMENT, SLOW FLOW PHENOMENON, TERM FOLLOW-UP, Cardiac syndrome X, Coronary flow reserve, Microvascular angina, Prognosis
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: EUROPEAN HEART JOURNAL
ISSN: 0195-668X
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Dates:
DateEvent
1 November 2012Published
Web of Science ID: WOS:000311303700008
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URI: https://openaccess.sgul.ac.uk/id/eprint/103268
Publisher's version: https://doi.org/10.1093/eurheartj/ehs246

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