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Review
. 2023 Feb 4;13(2):443.
doi: 10.3390/life13020443.

Ischemia with Nonobstructive Coronary Artery Disease and Atrial Cardiomyopathy-Two Sides of the Same Story?

Irina Afrăsânie  1   2 , Iulian Theodor Matei  1   2 , Sabina Andreea Leancă  1   2 , Adriana Chetran  1   2 , Alexandru Dan Costache  2   3 , Vlad-Adrian Afrăsânie  4   5 , Bianca-Ana Dmour  2 , Daniela Crișu  1 , Minerva Codruța Bădescu  2   6 , Lăcrămioara Ionela Șerban  7 , Irina Iuliana Costache  1   2
Affiliations
Review

Ischemia with Nonobstructive Coronary Artery Disease and Atrial Cardiomyopathy-Two Sides of the Same Story?

Irina Afrăsânie et al. Life (Basel). .

Abstract

Ischemia with nonobstructive coronary artery disease (INOCA) is increasingly recognized as a significant cause of angina, myocardial remodeling, and eventually heart failure (HF). Coronary microvascular dysfunction (CMD) is a major endotype of INOCA, and it is caused by structural and functional alterations of the coronary microcirculation. At the same time, atrial cardiomyopathy (ACM) defined by structural, functional, and electrical atrial remodeling has a major clinical impact due to its manifestations: atrial fibrillation (AF), atrial thrombosis, stroke, and HF symptoms. Both these pathologies share similar risk factors and have a high comorbidity burden. CMD causing INOCA and ACM frequently coexist. Thus, questions arise whether there is a potential link between these pathologies. Does CMD promote AF or the reverse? Which are the mechanisms that ultimately lead to CMD and ACM? Are both part of a systemic disease characterized by endothelial dysfunction? Lastly, which are the therapeutic strategies that can target endothelial dysfunction and improve the prognosis of patients with CMD and ACM? This review aims to address these questions by analyzing the existing body of evidence, offering further insight into the mechanisms of CMD and ACM, and discussing potential therapeutic strategies.

Keywords: INOCA; atrial cardiomyopathy; atrial fibrillation; comorbidities; coronary microvascular dysfunction; endothelial dysfunction; heart failure; systemic inflammation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The relationship between CMD, ACM, and ED. ACM, atrial cardiomyopathy; AF, atrial fibrillation; CMD, coronary microvascular dysfunction; ED, endothelial dysfunction; HFpEF, heart failure with preserved ejection fraction; INOCA, ischemia with nonobstructive coronary artery disease. This image was created with BioRender (https://biorender.com/ (accessed on 28 December 2022)).
Figure 2
Figure 2
Targeting endothelial dysfunction: a strategy to improve CMD and ACM. ACM, atrial cardiomyopathy; AF, atrial fibrillation; ACE-Is, angiotensin-converting enzyme inhibitors; ARNI, angiotensin receptor–neprilysin inhibitor; CMD, coronary microvascular dysfunction; CPAP, continuous positive airway pressure; EAT, epicardial adipose tissue; GLP-1RAs, glucagon-like peptide 1 receptor agonists; NO, nitric oxide; OSA, obstructive sleep apnea; ROS, reactive oxygen species; SGLT2-is, sodium–glucose cotransporter 2 inhibitors; VWF, von Willebrand Factor. This image was created with BioRender (https://biorender.com/ (accessed on 27 January 2022)).
See this image and copyright information in PMC

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