Neglia Danilo
Laboratorio PET Clinico, Istituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche, Pisa.
Recenti Prog Med. 2003 Jun;94(6):247-52.
There is growing evidence of the presence and relevance of coronary microvascular abnormalities in many cardiac diseases. In particular, it has been recently shown that dilated cardiomyopathy is characterized by coronary microvascular dysfunction since its early onset. Abnormal coronary microcirculatory function is not an effect of myocardial damage but in turn seems to be able to cause progressive contractile dysfunction, ventricular dilatation and heart failure. The mechanisms are largely unknown but both myocardial hypoperfusion and myocardial ischaemia are most probably involved. It has been demonstrated that in patients with dilated cardiomyopathy the presence of severe coronary microcirculatory dysfunction is an independent and relevant prognostic factor. From these studies it is more and more evident that coronary microvascular dysfunction is a new pathogenetic mechanism in dilated cardiomyopathy and that the coronary microcirculation should be considered a new target of treatment in cardiac diseases at risk to evolve towards heart failure.
越来越多的证据表明，在许多心脏疾病中存在冠状动脉微血管异常且具有相关性。特别是，最近研究表明，扩张型心肌病从疾病早期起就具有冠状动脉微血管功能障碍的特征。冠状动脉微循环功能异常并非心肌损伤的结果，相反，它似乎能够导致进行性收缩功能障碍、心室扩张和心力衰竭。其机制在很大程度上尚不清楚，但心肌灌注不足和心肌缺血很可能都参与其中。已经证明，在扩张型心肌病患者中，严重冠状动脉微循环功能障碍的存在是一个独立且相关的预后因素。从这些研究中越来越明显的是，冠状动脉微血管功能障碍是扩张型心肌病的一种新的发病机制，并且冠状动脉微循环应被视为有发展为心力衰竭风险的心脏疾病治疗的新靶点。
