Sweat the small stuff: The human microvasculature and heart disease.

Sweat the small stuff: The human microvasculature and heart disease.
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DOI:
10.1111/micc.12658
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发表时间:
2021-04
期刊:
Microcirculation (New York, N.Y. : 1994)
影响因子:
--
通讯作者:
Freed JK
Freed JK
中科院分区:
其他
文献类型:
--
作者:
Katunaric B;Cohen KE;Beyer AM;Gutterman DD;Freed JK

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传统上认为主要作为心肌灌注的主要调节器,越来越多地接受的是,人类冠状动脉微血管也对周围心肌施加更直接的影响。冠状动脉微血管功能障碍(CMD)不仅先于大动脉粥样硬化,而且与其他心血管疾病如射血分数保留的心力衰竭和肥厚性心肌病有关。它还高度预测有或无动脉粥样硬化性心血管疾病患者的心血管事件。本文综述了这一最近的范式转变,并深入探讨了CMD的临床后果。阻力小动脉如何有助于疾病的概念将进行讨论,强调微血管系统如何可能作为一个潜在的目标,新的治疗和干预。最后,有创和无创的方法来评估冠状动脉微血管的诊断和危险分层的目的将进行审查。
Traditionally thought of primarily as the predominant regulator of myocardial perfusion, it is becoming more accepted that the human coronary microvasculature also exerts a more direct influence on the surrounding myocardium. Coronary microvascular dysfunction (CMD) not only precedes large artery atherosclerosis, but is associated with other cardiovascular diseases such as heart failure with preserved ejection fraction and hypertrophic cardiomyopathy. It is also highly predictive of cardiovascular events in patients with or without atherosclerotic cardiovascular disease. This review focuses on this recent paradigm shift and delves into the clinical consequences of CMD. Concepts of how resistance arterioles contribute to disease will be discussed, highlighting how the microvasculature may serve as a potential target for novel therapies and interventions. Finally, both invasive and non-invasive methods with which to assess the coronary microvasculature both for diagnostic and risk stratification purposes will be reviewed.
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