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Review
. 2021 Apr;28(3):e12658.
doi: 10.1111/micc.12658. Epub 2020 Sep 29.

Sweat the small stuff: The human microvasculature and heart disease

Boran Katunaric  1   2 , Katie E Cohen  2   3 , Andreas M Beyer  2   3 , David D Gutterman  2   3 , Julie K Freed  1   2
Affiliations
Review

Sweat the small stuff: The human microvasculature and heart disease

Boran Katunaric et al. Microcirculation. 2021 Apr.

Abstract

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.

Keywords: clinical; coronary; flow-induced dilation; nitric oxide.

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Figures

FIGURE 1
FIGURE 1
The microcirculation as a driver of disease. Coronary endothelial dysfunction, here defined as the release of H2O2 in response to an increase in blood flow, precedes the development of CAD, and may contribute to other cardiac pathologies including HFpEF and HCM. CAD, coronary artery disease; FID, flow-induced dilation; HFpEF, heart failure with preserved ejection fraction; HCM, hypertrophic cardiomyopathy
See this image and copyright information in PMC

References

    1. Patel MR, Dai D, Hernandez AF, et al. Prevalence and predictors of nonobstructive coronary artery disease identified with coronary angiography in contemporary clinical practice. Am Heart J. 2014;167:846–852.e2. - PubMed
    1. Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, Go AS. Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med. 2010;362:2155–2165. - PubMed
    1. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355:251–259. - PubMed
    1. Dunlay SM, Roger VL, Redfield MM. Epidemiology of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2017;14:591–602. - PubMed
    1. Taqueti VR, Di Carli MF. Coronary microvascular disease pathogenic mechanisms and therapeutic options: JACC State-of-the-Art Review. J Am Coll Cardiol. 2018;72:2625–2641. - PMC - PubMed

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