Tsuda Takeshi, Patel Gina
Nemours Cardiac Center, Nemours Children's Health, Wilmington, DE 19803, USA.
Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA.
Am Heart J Plus. 2024 Apr 12;42:100392. doi: 10.1016/j.ahjo.2024.100392. eCollection 2024 Jun.
Coronary microvascular dysfunction (CMD) encompasses a spectrum of structural and functional alterations in coronary microvasculature resulting in impaired coronary blood flow and consequent myocardial ischemia without obstruction in epicardial coronary artery. The pathogenesis of CMD is complex involving both functional and structural alteration in the coronary microcirculation. In adults, CMD is predominantly discussed in context with anginal chest pain or existing ischemic heart disease and its risk factors. The presence of CMD suggests increased risk of adverse cardiovascular events independent of coronary atherosclerosis. Coronary microvascular dysfunction is also known in children but is rarely recognized due to paucity of concommitent coronary artery disease. Thus, its clinical presentation, underlying mechanism of impaired microcirculation, and prognostic significance are poorly understood. In this review article, we will overview variable CMD reported in children and delineate its emerging clinical significance.
冠状动脉微血管功能障碍（CMD）包括冠状动脉微血管的一系列结构和功能改变，导致冠状动脉血流受损，进而引起心肌缺血，而心外膜冠状动脉并无阻塞。CMD的发病机制复杂，涉及冠状动脉微循环的功能和结构改变。在成年人中，CMD主要是在心绞痛或现有的缺血性心脏病及其危险因素的背景下进行讨论。CMD的存在表明，独立于冠状动脉粥样硬化之外，发生不良心血管事件的风险增加。冠状动脉微血管功能障碍在儿童中也存在，但由于合并冠状动脉疾病较少见，因此很少被认识到。因此，对其临床表现、微循环受损的潜在机制以及预后意义了解甚少。在这篇综述文章中，我们将概述儿童中报道的各种CMD，并阐述其新出现的临床意义。
