University of Zagreb School of Medicine, Department of Cardiovascular Diseases, University Hospital Centre Zagreb, Zagreb, Croatia.
Curr Pharm Des. 2018;24(25):2954-2959. doi: 10.2174/1381612824666180625143232.
The idea of coronary microcirculation playing a role in the pathophysiology of heart failure dates from decades ago, with authors hypothesizing that structural and functional alterations in the coronary microcirculation could potentially contribute to heart failure. It is known that in a wide range of primary cardiomyopathies, from dilated to hypertrophic, there are pathological alterations in myocardial vasculature structure and function, playing a role in the clinical course of the disease. Needless to say, many patients with normal epicardial coronary arteries can suffer from coronary microvascular dysfunction, that could lead to a wide variety of clinical problems - from impaired functional capacity to stable and unstable angina, Takotsubo syndrome, myocardial infarction with normal coronary arteries and can also end up with either acute or chronic heart failure. Furthermore, nowadays, it has been recognized that pathophysiology of the heart failure with preserved ejection fraction (HFpEF) is mainly due to the myocardial microcirculatory impairment. In heart failure with reduced ejection fraction (HFrEF) neurohumoral mechanisms affecting the peripheral vasculature have been identified as important factors in the development and progression of heart failure, leading to unfavourable remodelling, and thus some of them being important treatment targets. Among many new clinical scenarios where both myocardial and peripheral microcirculation play an important role, raising field of implantable continuous flow assist devices opens many questions and implies better understanding of their effects of microcirculation, as they usually lead to the improvement of end organ dysfunction caused by previous heart failure, which is probably through the positive effects of peripheral microcirculation.
早在几十年前，就有人提出冠状动脉微循环在心力衰竭的病理生理学中起作用的观点，作者假设冠状动脉微循环的结构和功能改变可能有助于心力衰竭的发生。众所周知，在广泛的原发性心肌病中，从扩张型到肥厚型，心肌血管结构和功能都存在病理性改变，在疾病的临床过程中发挥作用。不用说，许多心外膜冠状动脉正常的患者可能会出现冠状动脉微血管功能障碍，这可能导致各种各样的临床问题——从功能能力受损到稳定和不稳定型心绞痛、心尖球囊综合征、正常冠状动脉心肌梗死，也可能导致急性或慢性心力衰竭。此外，如今已经认识到射血分数保留的心力衰竭（HFpEF）的病理生理学主要是由于心肌微循环受损所致。在射血分数降低的心力衰竭（HFrEF）中，影响外周血管的神经体液机制已被确定为心力衰竭发生和进展的重要因素，导致不利的重塑，因此其中一些成为重要的治疗靶点。在许多新的临床情况下，心肌和外周微循环都发挥着重要作用，植入式连续流辅助装置的应用领域提出了许多问题，这需要更好地了解它们对微循环的影响，因为它们通常会改善先前心力衰竭引起的终末器官功能障碍，这可能是通过外周微循环的积极作用。
