Coronary Microvascular Dysfunction and Estrogen Receptor Signaling

Tunç, Elif; Eve, Alicia Arredondo; Madak-Erdoğan, Zeynep

doi:10.1016/j.tem.2019.11.001

Cited by 24 publications

(22 citation statements)

References 70 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Symptomatic women are generally older than men and often have greater number and severity of CV risk factors. Moreover, most patients are in the peri- or post-menopausal stage, suggesting that reduced levels of estrogen have a role in the development of CMD [ 118 ]. Angina in the absence of obstructive CAD is also psychologically relevant, as recognition of the ischemic heart disease may be delayed.…”

Section: Clinical Presentationmentioning

confidence: 99%

Coronary Microvascular Dysfunction

Vancheri¹,

Longo²,

Vancheri

et al. 2020

JCM

202

153

View full text Add to dashboard Cite

Many patients with chest pain undergoing coronary angiography do not show significant obstructive coronary lesions. A substantial proportion of these patients have abnormalities in the function and structure of coronary microcirculation due to endothelial and smooth muscle cell dysfunction. The coronary microcirculation has a fundamental role in the regulation of coronary blood flow in response to cardiac oxygen requirements. Impairment of this mechanism, defined as coronary microvascular dysfunction (CMD), carries an increased risk of adverse cardiovascular clinical outcomes. Coronary endothelial dysfunction accounts for approximately two-thirds of clinical conditions presenting with symptoms and signs of myocardial ischemia without obstructive coronary disease, termed “ischemia with non-obstructive coronary artery disease” (INOCA) and for a small proportion of “myocardial infarction with non-obstructive coronary artery disease” (MINOCA). More frequently, the clinical presentation of INOCA is microvascular angina due to CMD, while some patients present vasospastic angina due to epicardial spasm, and mixed epicardial and microvascular forms. CMD may be associated with focal and diffuse epicardial coronary atherosclerosis, which may reinforce each other. Both INOCA and MINOCA are more common in females. Clinical classification of CMD includes the association with conditions in which atherosclerosis has limited relevance, with non-obstructive atherosclerosis, and with obstructive atherosclerosis. Several studies already exist which support the evidence that CMD is part of systemic microvascular disease involving multiple organs, such as brain and kidney. Moreover, CMD is strongly associated with the development of heart failure with preserved ejection fraction (HFpEF), diabetes, hypertensive heart disease, and also chronic inflammatory and autoimmune diseases. Since coronary microcirculation is not visible on invasive angiography or computed tomographic coronary angiography (CTCA), the diagnosis of CMD is usually based on functional assessment of microcirculation, which can be performed by both invasive and non-invasive methods, including the assessment of delayed flow of contrast during angiography, measurement of coronary flow reserve (CFR) and index of microvascular resistance (IMR), evaluation of angina induced by intracoronary acetylcholine infusion, and assessment of myocardial perfusion by positron emission tomography (PET) and magnetic resonance (CMR).

show abstract

Section: Clinical Presentationmentioning

confidence: 99%

Coronary Microvascular Dysfunction

Vancheri¹,

Longo²,

Vancheri

et al. 2020

JCM

202

153

View full text Add to dashboard Cite

show abstract

“…Despite the lack of consensus as to the CMD definition to date, it was described as perturbation of the function of coronary small-vessels or irregular coronary microvascular resistance on account of injured coronary perfusion and detrimental coronary blood flow. 70 Four major types of CMD have been classified, the mechanisms of which include luminal obstruction, vascular remodeling, endothelial dysfunction, smooth muscle cell dysfunction, automatic dysfunction, and extravascular compression (Table 1). 71…”

Section: Endothelialdysfunctionand Coagulatory Disordersmentioning

confidence: 99%

Coronary microvascular dysfunction pathophysiology in COVID‐19

et al. 2021

View full text Add to dashboard Cite

Recently, accumulating evidence has highlighted the role of endothelial dysfunction in COVID‐19 progression. Coronary microvascular dysfunction (CMD) plays a pivotal role in cardiovascular disease (CVD) and CVD‐related risk factors (eg, age, gender, hypertension, diabetes mellitus, and obesity). Equally, these are also risk factors for COVID‐19. The purpose of this review was to explore CMD pathophysiology in COVID‐19, based on recent evidence. COVID‐19 mechanisms were reviewed in terms of imbalanced renin‐angiotensin‐aldosterone‐systems (RAAS), systemic inflammation and immune responses, endothelial dysfunction, and coagulatory disorders. Based on these mechanisms, we addressed CMD pathophysiology within the context of COVID‐19, from five perspectives. The first was the disarrangement of local RAAS and Kallikrein‐kinin‐systems attributable to SARS‐Cov‐2 entry, and the concomitant decrease in coronary microvascular endothelial angiotensin I converting enzyme 2 (ACE2) levels. The second was related to coronary microvascular obstruction, induced by COVID‐19‐associated systemic hyper‐inflammation and pro‐thrombotic state. The third was focused on how pneumonia/acute respiratory distress syndrome (ARDS)‐related systemic hypoxia elicited oxidative stress in coronary microvessels and cardiac sympathetic nerve activation. Fourthly, we discussed how autonomic nerve dysfunction mediated by COVID‐19‐associated mental, physical, or physiological factors could elicit changes in coronary blood flow, resulting in CMD in COVID‐19 patients. Finally, we analyzed reciprocity between the coronary microvascular endothelium and perivascular cellular structures due to viremia, SARS‐CoV‐2 dissemination, and systemic inflammation. These mechanisms may function either consecutively or intermittently, finally culminating in CMD‐mediated cardiovascular symptoms in COVID‐19 patients. However, the underlying molecular pathogenesis remains to be clarified.

show abstract

“…The ER structure is mainly divided into five domains: transcription activation region-1 (AF-1), the DNA-binding domain, the ligand-binding domain (LBD), the hinge region, and transcription activation region-2 (AF-2) [ 37 ]. Each domain has its specific function, and the LBD is the key area where the ligand recognizes and binds the receptor and then triggers its effects [ 38 ].…”

Section: Action Mode Of Estrogenmentioning

confidence: 99%

Protective Effects of Estrogen on Cardiovascular Disease Mediated by Oxidative Stress

Liu

Zhou

et al. 2021

Oxidative Medicine and Cellular Longevity

View full text Add to dashboard Cite

Perimenopause is an important stage of female senescence. Epidemiological investigation has shown that the incidence of cardiovascular disease in premenopausal women is lower than that in men, and the incidence of cardiovascular disease in postmenopausal women is significantly higher than that in men. This phenomenon reveals that estrogen has a definite protective effect on the cardiovascular system. In the cardiovascular system, oxidative stress is considered important in the pathogenesis of atherosclerosis, myocardial dysfunction, cardiac hypertrophy, heart failure, and myocardial ischemia. From the perspective of oxidative stress, estrogen plays a regulatory role in the cardiovascular system through the estrogen receptor, providing strategies for the treatment of menopausal women with cardiovascular diseases.

show abstract

Coronary Microvascular Dysfunction and Estrogen Receptor Signaling

Cited by 24 publications

References 70 publications

Coronary Microvascular Dysfunction

Coronary Microvascular Dysfunction

Coronary microvascular dysfunction pathophysiology in COVID‐19

Protective Effects of Estrogen on Cardiovascular Disease Mediated by Oxidative Stress

Contact Info

Product

Resources

About