Microvascular Dysfunction as a Systemic Disease: A Review of the Evidence

Feuer, Daniel S.; Handberg, Eileen; Mehrad, Borna; Wei, Janet; Merz, C. Noel Bairey; Pepine, Carl J.; Keeley, Ellen C.

doi:10.1016/j.amjmed.2022.04.006

Cited by 31 publications

(18 citation statements)

References 77 publications

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“…[ 9 ]. Again, these mechanisms include an increase in the production of serotonin which is a mediator accompanying vasoconstrictive effects [ 109 , 110 , 111 ], of endothelin-1 [ 112 , 113 , 114 , 115 , 116 ], and neuropeptide Y [ 117 , 118 ]. Finally, inflammatory conditions in coronary microvasculature [ 119 , 120 ], with the consequent greater coronary vasoconstrictive reactivity, can induce coronary microvascular spasm.…”

Section: Resultsmentioning

confidence: 99%

Pathophysiology and Outcomes of Endothelium Function in Coronary Microvascular Diseases: A Systematic Review of Randomized Controlled Trials and Multicenter Study

Singh

Nappi

2022

Biomedicines

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Background: Coronary macrovascular disease is a concept that has been well-studied within the literature and has long been the subject of debates surrounding coronary artery bypass grafting (CABG) vs. Percutaneous Coronary Intervention (PCI). ISCHEMIA trial reported no statistical difference in the primary clinical endpoint between initial invasive management and initial conservative management, while in the ORBITA trial PCI did not improve angina frequency score significantly more than placebo, albeit PCI resulted in more patient-reported freedom from angina than placebo. However, these results did not prove the superiority of the PCI against OMT, therefore do not indicate the benefit of PCI vs. the OMT. Please rephrase the sentence. We reviewed the role of different factors responsible for endothelial dysfunction from recent randomized clinical trials (RCTs) and multicentre studies. Methods: A detailed search strategy was performed using a dataset that has previously been published. Data of pooled analysis include research articles (human and animal models), CABG, and PCI randomized controlled trials (RCTs). Details of the search strategy and the methods used for data pooling have been published previously and registered with Open-Source Framework. Results: The roles of nitric oxide (NO), endothelium-derived contracting factors (EDCFs), and vasodilator prostaglandins (e.g., prostacyclin), as well as endothelium-dependent hyperpolarization (EDH) factors, are crucial for the maintenance of vasomotor tone within the coronary vasculature. These homeostatic mechanisms are affected by sheer forces and other several factors that are currently being studied, such as vaping. The role of intracoronary testing is crucial when determining the effects of therapeutic medications with further studies on the horizon. Conclusion: The true impact of coronary microvascular dysfunction (CMD) is perhaps underappreciated, which supports the role of medical therapy in determining outcomes. Ongoing trials are underway to further investigate the role of therapeutic agents in secondary prevention.

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Section: Resultsmentioning

confidence: 99%

Pathophysiology and Outcomes of Endothelium Function in Coronary Microvascular Diseases: A Systematic Review of Randomized Controlled Trials and Multicenter Study

Singh

Nappi

2022

Biomedicines

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“…Ischemia could involve most of the organs/tissues including the heart, brain, peripheral vessels, limbs, skin, retina, intestine and kidney. 1,2 Ischemic diseases are the leading cause of disability and mortality which impose an enormous burden on human healthcare systems worldwide. 3 Although current therapies for reperfusion including thrombolytic drugs, using vasodilator, 4,5 surgical bypass, and endovascular intervention, 6 have shown significant benefits in the treatment of the ischemic damage, however, these therapies often are not optimal for remodelling vascular beds, thereby ischemic diseases remain the leading cause of long-term disability.…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…Ischemic disorders are the result of insufficiency in blood supply, leading to limited oxygen and nutrient transfer. Ischemia could involve most of the organs/tissues including the heart, brain, peripheral vessels, limbs, skin, retina, intestine and kidney 1,2 . Ischemic diseases are the leading cause of disability and mortality which impose an enormous burden on human healthcare systems worldwide 3 .…”

Section: Introductionmentioning

confidence: 99%

Exosomes for angiogenesis induction in ischemic disorders

Moeinabadi-Bidgoli

Rezaee

Babajani

et al. 2023

J Cellular Molecular Medi

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Ischaemic disorders are leading causes of morbidity and mortality worldwide. While the current therapeutic approaches have improved life expectancy and quality of life, they are unable to "cure" ischemic diseases and instate regeneration of damaged tissues. Exosomes are a class of extracellular vesicles with an average size of 100-150 nm, secreted by many cell types and considered a potent factor of cells for parac-

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“…1 ) [ 13 ] . So far, microcirculatory disorders have been widely explored in the context of intensive care medicine, mostly in septic shock, showing highly heterogeneous alterations with clear evidence of arteriolar–venular shunting [ 14 , 15 ] in different tissues including the lungs, the kidneys, the liver, the gastrointestinal tract and the brain [ 16 ]. Further studies are, therefore, still necessary focusing exclusively on microcirculation dysfunction in CS and its specificities [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Microcirculatory dysfunction in cardiogenic shock

Merdji

Lévy

Jung

et al. 2023

Ann. Intensive Care

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Cardiogenic shock is usually defined as primary cardiac dysfunction with low cardiac output leading to critical organ hypoperfusion, and tissue hypoxia, resulting in high mortality rate between 40% and 50% despite recent advances. Many studies have now evidenced that cardiogenic shock not only involves systemic macrocirculation, such as blood pressure, left ventricular ejection fraction, or cardiac output, but also involves significant systemic microcirculatory abnormalities which seem strongly associated with the outcome. Although microcirculation has been widely studied in the context of septic shock showing heterogeneous alterations with clear evidence of macro and microcirculation uncoupling, there is now a growing body of literature focusing on cardiogenic shock states. Even if there is currently no consensus regarding the treatment of microcirculatory disturbances in cardiogenic shock, some treatments seem to show a benefit. Furthermore, a better understanding of the underlying pathophysiology may provide hypotheses for future studies aiming to improve cardiogenic shock prognosis. Graphical Abstract

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Microvascular Dysfunction as a Systemic Disease: A Review of the Evidence

Cited by 31 publications

References 77 publications

Pathophysiology and Outcomes of Endothelium Function in Coronary Microvascular Diseases: A Systematic Review of Randomized Controlled Trials and Multicenter Study

Pathophysiology and Outcomes of Endothelium Function in Coronary Microvascular Diseases: A Systematic Review of Randomized Controlled Trials and Multicenter Study

Exosomes for angiogenesis induction in ischemic disorders

Microcirculatory dysfunction in cardiogenic shock

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