Sweat the small stuff: The human microvasculature and heart disease

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.

Assessment of the structural and functional state of blood vessels in patients with hypertrophic cardiomyopathy

“…При оценке состояния МЦР кожи пальца с применением КВК у пациентов с ГКМП нами впервые обнаружено статистически значимое снижение показателей, отображающих структурно-функциональные изменения. Примечательно, что в ряде исследований различных ССЗ оценка периферического МЦР отражает изменения, происходящие в микроциркуляции коронарного русла [19,20]. Кроме того, оценка капиллярного русла ногтевого ложа с применением КВК у пациентов с системной склеродермией достоверно ассоциирована с коронарной микроваскулярной дисфункцией, выявленной во время трансторакальной ЭхоКГ в виде снижения коронарного резерва перфузии [21].…”

Generation and characterisation of scalable and stable human pluripotent stem cell-derived microvascular-like endothelial cells for cardiac applications

“…Cardiac microvasculature has long been understudied, and its involvement in cardiac disease overlooked. This is in part due to the inability of conventional angiography to visualise the microvasculature [1]. However, the advent and adoption of advanced, non-invasive cardiac imaging modalities has helped illustrate the significance of this network and how it is impinged upon by cardiac risk factors and disease states, including COVID-19 [2].…”

“…Such factors elicit endothelialdependent and -independent mechanisms that perturb blood flow through the microvessels (arterioles, capillaries, and venules), thus disturbing oxygen supply to the myocardium. This microvascular dysfunction, termed coronary microvascular disease (CMD), may initially manifest as microvascular angina [3] but can proceed to major adverse cardiac events (MACE), including myocardial infarction with non-obstructive coronary artery disease [4] or heart failure with preserved ejection fraction (HFpEF) [1]. Intriguingly, women, as well as non-elderly individuals, are at a greater risk of MACE arising from CMD [4,5].…”

Generation and characterization of scalable and stable human pluripotent stem cell-derived microvascular-like endothelial cells for cardiac applications

“…Cardiac microvasculature has long been understudied, and its involvement in cardiac disease overlooked. This is in part due to the inability of conventional angiography to visualize the microvasculature [1]. However, the advent and adoption of advanced, non-invasive cardiac imaging modalities has helped illustrate the significance of this network and how it is impinged upon by cardiac risk factors and disease states, including COVID-19 [2].…”

“…Such factors elicit endothelial-dependent and -independent mechanisms that perturb blood flow through the microvessels (arterioles, capillaries, and venules), thus disturbing oxygen supply to the myocardium. This microvascular dysfunction, termed coronary microvascular disease (CMD), may initially manifest as microvascular angina [3] but can proceed to major adverse cardiac events (MACE), including myocardial infarction with no obstructive coronary artery disease [4] or heart failure with preserved ejection fraction (HFpEF) [1]. Intriguingly, women as well as non-elderly individuals, are at a greater risk of MACE arising from CMD [4,5].…”