Prakash Roshni O, Chakrala Teja S, Feuer Daniel S, Valdes Carlos A, Pepine Carl J, Keeley Ellen C
Department of Medicine, University of Florida, Gainesville, FL, United States of America.
Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States of America.
Am Heart J Plus. 2022 Oct 1;22:100215. doi: 10.1016/j.ahjo.2022.100215. eCollection 2022 Oct.
The coronary microvasculature is responsible for providing oxygen and nutrients to myocardial tissue. A healthy microvasculature with an intact and properly functioning endothelium accomplishes this by seemless changes in vascular tone to match supply and demand. Perturbations in the normal physiology of the microvasculature, including endothelial and/or vascular smooth muscle dysfunction, result in impaired function (vasoconstriction, antithrombotic, etc.) and structural (hypertrophic, fibrotic) abnormalities that lead to microvascular ischemia and potential organ damage. While coronary microvascular dysfunction (CMD) is the primary pathologic driving force in ischemia with non-obstructive coronary artery disease (INOCA), angina with no obstructive coronary arteries (ANOCA), and myocardial infarction with non-obstructed coronary arteries (MINOCA), it may be a bystander in many cardiac disorders which later become pathologically associated with signs and/or symptoms of myocardial ischemia. Importantly, regardless of the primary or secondary basis of CMD in the heart, it is associated with important increases in morbidity and mortality. In this review we discuss salient features pertaining to known pathophysiologic mechanisms driving CMD, the spectrum of heart diseases where it places a critical role, invasive and non-invasive diagnostic testing, management strategies, and the gaps in knowledge where future research efforts are needed.
冠状动脉微血管负责为心肌组织提供氧气和营养物质。健康的微血管具有完整且功能正常的内皮，通过血管张力的无缝变化来匹配供需，从而实现这一功能。微血管正常生理功能的紊乱，包括内皮和/或血管平滑肌功能障碍，会导致功能受损（血管收缩、抗血栓形成等）以及结构异常（肥厚、纤维化），进而导致微血管缺血和潜在的器官损伤。虽然冠状动脉微血管功能障碍（CMD）是无阻塞性冠状动脉疾病（INOCA）、无阻塞性冠状动脉心绞痛（ANOCA）和无阻塞性冠状动脉心肌梗死（MINOCA）中缺血的主要病理驱动因素，但在许多后来与心肌缺血体征和/或症状在病理上相关的心脏疾病中，它可能是一个旁观者。重要的是，无论CMD在心脏中是原发性还是继发性的，它都与发病率和死亡率的显著增加相关。在这篇综述中，我们讨论了与驱动CMD的已知病理生理机制相关的显著特征、它起关键作用的心脏病谱、有创和无创诊断测试、管理策略以及需要未来研究努力填补的知识空白。
