Unit of Cardiology, University Hospital Paolo Giaccone, University of Palermo, Palermo, Italy.
Department of Excellence of Sciences for Health Promotion and Maternal-Child Care, Internal Medicine and Specialties (ProMISE), University of Palermo, Palermo, Italy.
Angiology. 2022 May;73(5):395-406. doi: 10.1177/00033197211034267. Epub 2021 Aug 2.
The current gold standard for diagnosis of coronary microvascular dysfunction (CMD) in the absence of myocardial diseases, whose clinical manifestation is microvascular angina (MVA), is reactivity testing using adenosine or acetylcholine during coronary angiography. This invasive test can be difficult to perform, expensive, and harmful. The identification of easily obtainable blood biomarkers which reflect the pathophysiology of CMD, characterized by high reliability, precision, accuracy, and accessibility may reduce risks and costs related to invasive procedures and even facilitate the screening and diagnosis of CMD. In this review, we summarized the results of several studies that have investigated the possible relationships between blood biomarkers involved with CMD and MVA. More specifically, we have divided the analyzed biomarkers into 3 different groups, according to the main mechanisms underlying CMD: biomarkers of "endothelial dysfunction," "vascular inflammation," and "oxidative stress." Finally, in the last section of the review, we consider mixed mechanisms and biomarkers which are not included in the 3 major categories mentioned above, but could be involved in the pathogenesis of CMD.
目前，在没有心肌疾病的情况下，诊断冠状动脉微血管功能障碍（CMD）的金标准是在冠状动脉造影时使用腺苷或乙酰胆碱进行反应性测试。这种有创性检查可能难以进行、昂贵且有危害。识别易于获得的血液生物标志物，这些标志物反映了 CMD 的病理生理学特征，具有高可靠性、精度、准确性和可及性，可能会降低与侵入性操作相关的风险和成本，甚至有助于 CMD 的筛查和诊断。在这篇综述中，我们总结了几项研究的结果，这些研究调查了与 CMD 和 MVA 相关的血液生物标志物之间的可能关系。更具体地说，我们根据 CMD 的主要机制将分析的生物标志物分为 3 个不同组：“内皮功能障碍”、“血管炎症”和“氧化应激”的生物标志物。最后，在综述的最后一节，我们考虑了混合机制和生物标志物，这些标志物不属于上述 3 个主要类别，但可能参与 CMD 的发病机制。
