Moroni Francesco, Ammirati Enrico, Hainsworth Atticus H, Camici Paolo G
Cardiothoracic and Vascular Department, Vita-Salute University and San Raffaele Hospital, Milan, Italy (F.M., P.G.C.).
De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (E.A.).
Circ Cardiovasc Imaging. 2020 Aug;13(8):e010460. doi: 10.1161/CIRCIMAGING.120.010460. Epub 2020 Jul 28.
Cardiac and cerebrovascular diseases are currently the leading causes of mortality and disability worldwide. Both the heart and brain display similar vascular anatomy, with large conduit arteries running on the surface of the organ providing tissue perfusion through an intricate network of penetrating small vessels. Both organs rely on fine tuning of local blood flow to match metabolic demand. Blood flow regulation requires adequate functioning of the microcirculation in both organs, with loss of microvascular function, termed small vessel disease (SVD) underlying different potential clinical manifestations. SVD in the heart, known as coronary microvascular dysfunction, can cause chronic or acute myocardial ischemia and may lead to development of heart failure. In the brain, cerebral SVD can cause an acute stroke syndrome known as lacunar stroke or more subtle pathological alterations of the brain parenchyma, which may eventually lead to neurological deficits or cognitive decline in the long term. Coronary microcirculation cannot be visualized in vivo in humans, and functional information can be deduced by measuring the coronary flow reserve. The diagnosis of cerebral SVD is largely based on brain magnetic resonance imaging, with white matter hyperintensities, microbleeds, and brain atrophy reflecting key structural changes. There is evidence that such structural changes reflect underlying cerebral SVD. Here, we review interactions between SVD and cardiovascular risk factors, and we discuss the evidence linking cerebral SVD with large vessel atheroma, atrial fibrillation, heart failure, and heart valve disease.
心血管疾病目前是全球死亡和残疾的主要原因。心脏和大脑具有相似的血管解剖结构，器官表面有大的输送动脉，通过复杂的穿通小血管网络为组织提供灌注。两个器官都依赖于局部血流的精细调节以匹配代谢需求。血流调节需要两个器官的微循环功能正常，微血管功能丧失，即所谓的小血管疾病（SVD），是不同潜在临床表现的基础。心脏中的SVD，即冠状动脉微血管功能障碍，可导致慢性或急性心肌缺血，并可能导致心力衰竭的发生。在大脑中，脑SVD可导致一种称为腔隙性卒中的急性卒中综合征，或脑实质更细微的病理改变，长期来看最终可能导致神经功能缺损或认知功能下降。人体冠状动脉微循环无法在体内可视化，功能信息可通过测量冠状动脉血流储备来推断。脑SVD的诊断主要基于脑磁共振成像，白质高信号、微出血和脑萎缩反映了关键的结构变化。有证据表明这些结构变化反映了潜在的脑SVD。在此，我们综述SVD与心血管危险因素之间的相互作用，并讨论将脑SVD与大血管动脉粥样硬化、心房颤动、心力衰竭和心脏瓣膜病联系起来的证据。
