Ischemic Heart Disease and Heart Failure: Role of Coronary Ion Channels

Abstract

Heart failure is a complex syndrome responsible for high rates of death and hospitalization. Ischemic heart disease is one of the most frequent causes of heart failure and it is normally attributed to coronary artery disease, defined by the presence of one or more obstructive plaques, which determine a reduced coronary blood flow, causing myocardial ischemia and consequent heart failure. However, coronary obstruction is only an element of a complex pathophysiological process that leads to myocardial ischemia. In the literature, attention paid to the role of microcirculation, in the pathophysiology of ischemic heart disease and heart failure, is growing. Coronary microvascular dysfunction determines an inability of coronary circulation to satisfy myocardial metabolic demands, due to the imbalance of coronary blood flow regulatory mechanisms, including ion channels, leading to the development of hypoxia, fibrosis and tissue death, which may determine a loss of myocardial function, even beyond the presence of atherosclerotic epicardial plaques. For this reason, ion channels may represent the link among coronary microvascular dysfunction, ischemic heart disease and consequent heart failure.

Impact of Renal Function on Long-Term Clinical Outcomes in Patients With Coronary Chronic Total Occlusions: Results From an Observational Single-Center Cohort Study During the Last 12 Years

“…Renal impairment is associated with inflammatory, oxidative stress, and metabolic perturbations and coronary microcirculation disorders (1,(19)(20)(21)(22), all of which are associated with accelerated atherosclerosis and endothelial dysfunction and increased incidence of hypertension, diabetes mellitus, dyslipidemia, multivessel disease, and coronary calcified lesions (23,24). These may be the mechanisms that renal dysfunction contribute to adverse short-term as well as long-term outcomes.…”

Sex Difference in Risk Factors, GRACE Scores, and Management among Post-Acute Coronary Syndrome Patients in Sri Lanka

“…Coronary ion channels are important in the cross-talk between myocardial metabolism and coronary blood flow, and it may represent the link among coronary microvascular dysfunction, ischemic heart disease, and consequent heart failure. Specially, some genetic variants for ATP-dependent potassium channels seem to be involved in the determinism of IHD [19][20][21]. Similarly, much higher prevalence of dyslipidemia (without a significant sex difference) was observed in the PROMISE (M: 67.8% vs F: 67.1%) and SURF studies (M: 78% vs F: 73%).…”

Aortic Root Remodeling as an Indicator for Diastolic Dysfunction and Normative Ranges in Asians: Comparison and Validation with Multidetector Computed Tomography

“…Typically, medial degeneration (MD) involves elastic fiber fragmentation and smooth muscle cell loss from cycled damage in the aging aorta or from unfavorable vascular wall hemodynamics [31]. On the other hand, several clinical comorbidities may trigger proinflammatory responses and impaired downstream endothelial nitric oxide (eNO) production complicating both altered vascular arterial properties and aggravated myocardial ischemia, which likely contribute to the pathogenesis of DD or HF (i.e., HFpEF) [32,33]. Although conflicting data exist regarding the true impact of hypertension and systolic blood pressure on aortic root dilation [34][35][36], we did observe a consistent relationship between higher diastolic blood pressure and greater aortic diameter in our Asian population.…”