Belmonte Marta, Foà Alberto, Paolisso Pasquale, Bergamaschi Luca, Gallinoro Emanuele, Polimeni Alberto, Scarsini Roberto, Muscoli Saverio, Amicone Sara, De Vita Antonio, Villano Angelo, Angeli Francesco, Armillotta Matteo, Sucato Vincenzo, Tremamunno Saverio, Morrone Doralisa, Indolfi Ciro, Filardi Pasquale Perrone, Ribichini Flavio, Lanza Gaetano Antonio, Chieffo Alaide, Barbato Emanuele, Pizzi Carmine
Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna; Department of Medical and Surgical Sciences - DIMEC; Alma Mater Studiorum, University of Bologna, Italy.
Prog Cardiovasc Dis. 2024 Nov-Dec;87:73-82. doi: 10.1016/j.pcad.2024.10.006. Epub 2024 Oct 22.
The prevalence of coronary microvascular dysfunction (CMD) beyond the spectrum of chronic coronary syndromes (CCS) is non-negligible, pertaining to pathophysiological and therapeutical implications. Thanks to the availability of accurate and safe non-invasive technique, CMD can be identified as a key player in heart failure, cardiomyopathies, Takotsubo syndrome, aortic stenosis. While CMD is widely recognized as a cause of myocardial ischemia leading to a worse prognosis even in the absence of obstructive coronary artery disease, the characterization of CMD patterns beyond CCS might provide valuable insights on the underlying disease progression, being potentially a "red flag" of adverse cardiac remodeling and a major determinant of response to therapy and outcomes. In this review, we aimed to provide an overview of the latest evidence on the prevalence, mechanistic and prognostic implications of CMD beyond the spectrum of CCS (i.e. heart failure, cardiomyopathies, Takotsubo syndrome, aortic stenosis).
慢性冠状动脉综合征（CCS）范围之外的冠状动脉微血管功能障碍（CMD）的患病率不可忽视，这涉及病理生理学和治疗学意义。由于有了准确且安全的非侵入性技术，CMD可被确定为心力衰竭、心肌病、应激性心肌病、主动脉狭窄中的关键因素。虽然CMD被广泛认为是即使在没有阻塞性冠状动脉疾病的情况下也会导致预后更差的心肌缺血原因，但CCS范围之外的CMD模式特征可能为潜在的疾病进展提供有价值的见解，可能是心脏不良重塑的“危险信号”以及治疗反应和结果的主要决定因素。在本综述中，我们旨在概述CCS范围之外（即心力衰竭、心肌病、应激性心肌病、主动脉狭窄）CMD的患病率、机制及预后意义的最新证据。
