Coronary microvascular dysfunction and cardiovascular disease: Pathogenesis, associations and treatment strategies

Yang, Zhihua; Liu, Yangxi; Li, Zhenzhen; Feng, Shaoling; Lin, Shanshan; Zhao, Guisen; Fan, Yue‐Mei; Wang, Yi; Wang, Xianliang; Mao, Jingyuan

doi:10.1016/j.biopha.2023.115011

Cited by 10 publications

(7 citation statements)

References 153 publications

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“…In addition, MetS can change the structure of microvascular and lead to microvascular dysfunction. And in this situation, the brain and heart may experience hypoxia and metabolic abnormalities due to insufficient blood supply, which furthermore increases the risk of CVD ( 38 , 39 ). The findings of this study support the causal relationship between MetS and CVD from an epidemiological perspective, Notably, we found the positive correlation between the MetS severity score and CVD risk was more pronounced in urban populations, possibly due to urban residents having lower levels of physical activity or being more likely to be over-nourished or exposed to more pollution than rural residents ( 40 – 42 ).…”

Section: Discussionmentioning

confidence: 99%

Association between metabolic syndrome severity score and cardiovascular disease: results from a longitudinal cohort study on Chinese adults

Lin,

Dai,

Zhang

et al. 2024

Front. Endocrinol.

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ObjectiveThis study aimed to quantify the severity of metabolic syndrome(MetS) and investigate its association with cardiovascular disease(CVD) risk on Chinese adults.Methods13,500 participants from the Zhejiang Adult Chronic Disease Study were followed up between 2010 and 2021. A continuous MetS severity score derived from the five components of MetS was used to quantify MetS severity, and the association between MetS severity and the risk of incident CVD was assessed using Cox proportional hazard and restricted cubic spline regression.ResultsBoth the presence and severity of MetS were strongly associated with CVD risk. MetS was related to an increased risk of CVD (hazard ratio(HR):1.700, 95% confidence interval(CI): 1.380–2.094). Compared with the hazard ratio for CVD in the lowest quartile of the MetS severity score, that in the second, third, and highest quartiles were 1.812 (1.329–2.470), 1.746 (1.265–2.410), and 2.817 (2.015–3.938), respectively. A linear and positive dose-response relationship was observed between the MetS severity and CVD risk (P for non-linearity = 0.437). Similar results were found in various sensitivity analyses.ConclusionThe MetS severity score was significantly associated with CVD risk. Assessing MetS severity and further ensuring intervention measures according to the different severities of MetS may be more useful in preventing CVD.

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Section: Discussionmentioning

confidence: 99%

Association between metabolic syndrome severity score and cardiovascular disease: results from a longitudinal cohort study on Chinese adults

Lin,

Dai,

Zhang

et al. 2024

Front. Endocrinol.

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“…There is still a lack of objective and accurate epidemiological ndings on the actual incidence of CMD, but more and more studies have begun to pay attention to the relationship between CMD and the occurrence and progression of various cardiovascular diseases [14]. The lack of typical clinical symptoms in the early stage of patients with HFpEF, and the lack of clear organiceven though coronary artery disease is the main cause of heart failure, a signi cant proportion of patients present with no signi cant coronary artery stenosis, and the possibility of CMD needs to be considered [15]. The research shows that LVEF decreases and BNP and LVGLS increase in the CMD group, suggesting that the presence of CMD may reduce cardiac function and myocardial strain, thus affecting ventricular remodeling and cardiac pumping function.…”

Section: Discussionmentioning

confidence: 99%

Myocardial Contrast Echocardiography Evaluation of Coronary Microvascular Dysfunction to Predict MACEs in Patients with Heart Failure with Preserved Ejection Fraction Follow-up

Chen,

Weng,

Yang

et al. 2024

Preprint

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Background: Myocardial contrast echocardiography (MCE) is used to evaluate the accuracy of Coronary microvascular dysfunction (CMD) for predicting major adverse cardiac events (MACEs) in patients with heart failure with preserved ejection fraction (HFpEF) at follow-up. Methods: The clinical data of 142 patients diagnosed with HFpEF in our hospital from January 2020 to January 2022 were retrospectively summarized and stratified into 77 cases (>1) in the CMD group and 65 cases (=1) in the non-CMD group based on the perfusion score index (PSI) of the 17 segments of the left ventricle examined by the admission MCE, and the perfusion parameters were measured at the same time, including the peak plateau intensity (A value), the curve slope of the curve rise (βvalue) and A×β values. At a median follow-up of 27 months till October 2023, MACEs were recorded mainly including heart failure exacerbation, revascularization, cardiac death, etc. Results: Increasing age, hypertension, diabetes, and coronary artery disease in the CMD group resulted in decreased left ventricular ejection fraction (LVEF), increased plasma NT-B-type natriuretic peptide (BNP) and left ventricular global longitudinal strain (LVGLS), decreased A-values and A×β-values, and an increased incidence of MACEs (P < 0.05). Univariate and multivariate Cox regression analyses showed that LVGLS (HR = 1.714, 95% CI = 1.289 - 2.279, P < 0.001) and A×β values (HR = 0.636, 95% CI = 0.417 to 0.969, P = 0.035) were independent predictors of MACEs in patients with HFpEF. The receiver operating characteristic curve (ROC) showed that the area under the curve (AUC) of LVGLS combined with A×β value for diagnosis of MACEs was 0.861 (95% CI=0.761~0.961, P<0.001), which was significantly higher than that of LVGLS or A×β value (P<0.05). The Kaplan-Meier survival curves showed that the cumulative survival rate in CMD group was significantly lower than non-CMD group (logrank χ2 =6.626, P=0.010), with the most significant difference at 20 months of follow-up. Conclusion: MCE can evaluate CMD semi-quantitatively and quantitatively, LVGLS combined with A×β value has good performance in predicting the risk of developing MACEs in patients with HFpEF at 3 years of follow-up, and CMD can be used as an important non-invasive indicator for assessing clinical prognosis.

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“…Ivabradine weakens the gene expression of inflammatory mediators, specifically TNFα, IL-7, IL-84β, and multiple inflammatory cell nuclei, in an animal model of ventricular remodeling. Furthermore, it provides a safeguard against ventricular remodeling and adverse cardiovascular events that arise after CMVD by limiting inflammatory responses ( 3 ).…”

Section: Delaying the Development Of Cmvd By Modulating The Inflammat...mentioning

confidence: 99%

“…CMVD is a clinical syndrome of acute and chronic myocardial ischemia caused by abnormalities in the structure and function of coronary arterioles, arterioles, and capillaries induced by atherosclerotic and non-atherosclerotic pathogenic factors ( 2 ). According to different etiologies, CMVD is classified as CMVD without obstructive coronary artery disease, CMVD with obstructive coronary artery disease, and other types of CMVD ( 3 ). CMVD is a multifactorial disease that is prevalent in cardiovascular diseases such as obstructive coronary artery disease, myocardial infarction with no obstructive coronary artery disease, ischemia with non-obstructive coronary arteries, heart failure with preserved ejection fraction, diabetic cardiomyopathy, dilated cardiomyopathy, and hypertrophic cardiomyopathy, and it can affect the pathophysiological mechanisms and prognosis of specific populations ( 4 ).…”

Section: Introductionmentioning

confidence: 99%

“…coronary artery disease, CMVD with obstructive coronary artery disease, and other types of CMVD (3). CMVD is a multifactorial disease that is prevalent in cardiovascular diseases such as obstructive coronary artery disease, myocardial infarction with no obstructive coronary artery disease, ischemia with non-obstructive coronary arteries, heart failure with preserved ejection fraction, diabetic cardiomyopathy, dilated cardiomyopathy, and hypertrophic cardiomyopathy, and it can affect the pathophysiological mechanisms and prognosis of specific populations (4).…”

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confidence: 99%

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Inflammation and coronary microvascular disease: relationship, mechanism and treatment

Guo,

Yang,

Song

et al. 2024

Front. Cardiovasc. Med.

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Coronary microvascular disease (CMVD) is common in patients with cardiovascular risk factors and is linked to an elevated risk of adverse cardiovascular events. Although modern medicine has made significant strides in researching CMVD, we still lack a comprehensive understanding of its pathophysiological mechanisms due to its complex and somewhat cryptic etiology. This greatly impedes the clinical diagnosis and treatment of CMVD. The primary pathological mechanisms of CMVD are structural abnormalities and/or dysfunction of coronary microvascular endothelial cells. The development of CMVD may also involve a variety of inflammatory factors through the endothelial cell injury pathway. This paper first reviews the correlation between the inflammatory response and CMVD, then summarizes the possible mechanisms of inflammatory response in CMVD, and finally categorizes the drugs used to treat CMVD based on their effect on the inflammatory response. We hope that this paper draws attention to CMVD and provides novel ideas for potential therapeutic strategies based on the inflammatory response.

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Coronary microvascular dysfunction and cardiovascular disease: Pathogenesis, associations and treatment strategies

Cited by 10 publications

References 153 publications

Association between metabolic syndrome severity score and cardiovascular disease: results from a longitudinal cohort study on Chinese adults

Association between metabolic syndrome severity score and cardiovascular disease: results from a longitudinal cohort study on Chinese adults

Myocardial Contrast Echocardiography Evaluation of Coronary Microvascular Dysfunction to Predict MACEs in Patients with Heart Failure with Preserved Ejection Fraction Follow-up

Inflammation and coronary microvascular disease: relationship, mechanism and treatment

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