Sarwar Shihab, Ahmed Faisal, Kadoya Yoshito, Hakimjavadi Ramtin, Boczar Kevin Emery
Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada.
School of Epidemiology and Public Health, Department of Medicine, University of Ottawa, Ottawa, Canada.
Curr Cardiol Rep. 2025 Apr 8;27(1):81. doi: 10.1007/s11886-025-02231-w.
Coronary microvascular dysfunction (CMD) is characterized by impaired coronary blood flow in the absence of obstructive coronary artery disease. CMD primarily involves the microvasculature, leading to myocardial ischemia, angina, and increased cardiovascular risk. Systemic vasculitides (e.g., giant cell arteritis, antineutrophil cytoplasmic antibody-associated vasculitis, and Takayasu arteritis) are a group of autoimmune conditions known to affect the vasculature through inflammation of the blood vessels that have been associated with more prevalent and severe CMD. Although systemic inflammation likely plays a role in the increased risk of cardiovascular events, the underlying pathogenesis is not well understood.
Invasive and non-invasive techniques for assessing coronary microvascular function have been developed to assess for blood flow and coronary flow reserve (CFR), defined as the ratio of the maximum achievable blood flow during stress to the resting blood flow. The purpose of this review is to further explore the relationship between vasculitis and CMD as well as the techniques available for assessing this association.
Studies have shown that CMD is significantly more prevalent in patients with systemic vasculitis compared to the general population. Moreover, in the absence of significant atherosclerotic burden, patients with vasculitis have a lower CFR than controls, indicating more severely impaired coronary vasomotor function. This suggests that systemic inflammation itself is a factor in driving coronary vasomotor abnormalities and CMD development. CMD contributes to cardiovascular morbidity in patients with systemic vasculitis, underscoring the need for early recognition and management. Further studies are needed to determine whether therapies targeting the reduction of systemic inflammation can lead to improved coronary microvascular function and cardiovascular outcomes.
冠状动脉微血管功能障碍（CMD）的特征是在无阻塞性冠状动脉疾病的情况下冠状动脉血流受损。CMD主要累及微血管，导致心肌缺血、心绞痛和心血管风险增加。系统性血管炎（如巨细胞动脉炎、抗中性粒细胞胞浆抗体相关性血管炎和大动脉炎）是一组自身免疫性疾病，已知通过血管炎症影响血管系统，这些疾病与更普遍和严重的CMD相关。尽管全身炎症可能在心血管事件风险增加中起作用，但其潜在发病机制尚不清楚。
已开发出用于评估冠状动脉微血管功能的有创和无创技术，以评估血流和冠状动脉血流储备（CFR），CFR定义为应激时可达到的最大血流与静息血流的比值。本综述的目的是进一步探讨血管炎与CMD之间的关系以及可用于评估这种关联的技术。
研究表明，与普通人群相比，CMD在系统性血管炎患者中更为普遍。此外，在没有明显动脉粥样硬化负担的情况下，血管炎患者的CFR低于对照组，表明冠状动脉血管舒缩功能受损更严重。这表明全身炎症本身是导致冠状动脉血管舒缩异常和CMD发展的一个因素。CMD导致系统性血管炎患者的心血管发病率增加，强调了早期识别和管理的必要性。需要进一步研究以确定针对减轻全身炎症的治疗是否能改善冠状动脉微血管功能和心血管结局。
