Coronary Microvascular Dysfunction

Foreword......Page 5
Contents......Page 7
Abbreviations......Page 11
Part IPhysiology, Pathophysiology and Assessment of Coronary Microcirculation......Page 13
1.1…Functional Anatomy of the Coronary Circulation......Page 14
1.1.1 Distribution of Coronary Vascular Resistance in Series......Page 16
1.1.3 Mechanisms Regulating Myocardial Blood Flow......Page 17
1.1.3.1 Response to Changes in Flow......Page 18
1.1.3.3 Response to Changes in Perfusion Pressure: Autoregulation......Page 19
1.1.3.4 Response to Changes in Myocardial Oxygen Consumption: Metabolic Regulation......Page 21
1.1.3.5 Determinants of Myocardial Oxygen Consumption......Page 23
1.1.3.6 Mechanisms of Metabolic Regulation of Coronary Blood Flow......Page 24
1.1.4.1 Sympathetic Control......Page 27
1.1.5.1 Response to a Brief Coronary Occlusion......Page 29
1.1.5.2 Coronary Flow ReserveCoronary flow reserve......Page 30
1.1.5.3 Coronary Flow Reserve Versus Maximum Blood Flow......Page 33
1.1.6 Collateral CirculationCollateral circulation......Page 34
References......Page 37
2.1…Structural Alterations......Page 42
2.2…Functional Alterations......Page 46
2.2.1 Alterations of Endothelium-Dependent Vasodilatation......Page 47
2.2.2 Alterations of Endothelium-Independent Vasodilatation......Page 49
2.2.3 Vasoconstriction......Page 50
2.2.4 Intravascular Plugging......Page 51
2.3.1 Extramural Compression......Page 52
2.3.2 Tissue Edema......Page 53
References......Page 54
3.1…Issues Related to Assessment of CMD......Page 59
3.2…Vasoactive Stimuli for Assessment of CMD......Page 60
3.3.1 Transthoracic Doppler Echocardiography......Page 62
3.3.2 Myocardial Contrast Echocardiography......Page 65
3.3.3 Positron Emission Tomography......Page 69
3.3.4 Cardiac Magnetic Resonance......Page 71
3.4.1 ThermodiluitionThermodiluition......Page 73
3.4.3 Intracoronary Doppler Flow WireIntracoronary Doppler flow wire......Page 74
References......Page 76
Part IIClinical Manifestations of Coronary Microvascular Dysfunction......Page 83
4.1.1 SmokingSmoking......Page 84
4.1.2 HypercholesterolemiaHypercholesterolemia......Page 86
4.1.3 HypertensionHypertension......Page 88
4.1.4 DiabetesDiabetes and Insulin Resistanceinsulin Resistance......Page 91
4.1.5 InflammationInflammation......Page 93
4.2.1 Evidence of Myocardial Ischemiamyocardial ischemia......Page 95
4.2.2 Evidence of CMD......Page 98
4.2.2.2 Alterations of Endothelium-Independent Vasodilatationendothelium-independent vasodilatation......Page 99
4.2.2.3 Alterations of Endothelium-Dependent Vasodilatationendothelium-dependent vasodilatation......Page 100
4.2.2.4 Abnormalities in Vasoconstrictor Responsevasoconstrictor response......Page 102
4.2.3 Causes of CMDCauses of CMD......Page 103
4.2.4 Enhanced Pain Perceptionpain perception......Page 104
4.2.5 DiagnosisDiagnosis......Page 105
4.2.6 PrognosisPrognosis......Page 107
4.3.1 DefinitionDefinition and Epidemiology......Page 108
4.3.2 PathophysiologyPathophysiology......Page 109
4.3.4 Prognosis......Page 110
4.5…Takotsubo or Stress-Related CardiomyopathyTakotsubo or stress-related cardiomyopathy......Page 111
References......Page 113
5.1…Hypertrophic Cardiomyopathy......Page 124
5.2…Dilated Cardiomyopathy......Page 128
5.3…Aortic Stenosis......Page 132
5.4…Myocarditis......Page 136
5.5…Infiltrative Heart Diseases......Page 138
5.5.1 Anderson-Fabry Disease......Page 139
5.5.2 Amyloidosis......Page 141
References......Page 146
6.1.1 PathophysiologyPathophysiology of CMD......Page 153
6.1.2 Clinical Implications......Page 160
6.2.1 Pathophysiology of CMD......Page 163
6.2.2 Relations Between CMD and Plaques Instability......Page 166
6.3.2 Time-Course and Pathogenetic Components......Page 170
6.3.3 Predictors of the Different Pathogenetic Components of MVO......Page 175
6.3.4 Diagnosis......Page 177
References......Page 179
7.1…Percutaneous Interventions......Page 189
7.2…Surgical Interventions......Page 195
References......Page 197
Part IIITherapeutic Approaches to Coronary Microvascular Dysfunction......Page 201
8.1.1 HypertensionHypertension......Page 202
8.1.4 Other Cardiovascular Risk Factors......Page 204
8.2.1.1 Beta-BlockersBeta-blockers......Page 205
8.2.1.3 NitratesNitrates......Page 207
8.2.2.1 Xanthine Derivatives......Page 209
8.2.2.3 Alpha Antagonist DrugsAlpha antagonist drugs......Page 212
8.2.2.4 NicorandilNicorandil......Page 213
8.2.2.7 IvabradineIvabradine......Page 214
8.2.2.9 EstrogensEstrogens......Page 215
8.2.3 Drugs Modulating Pain Perception......Page 216
8.2.4.2 Transcutaneous Electrical Nerve StimulationTranscutaneous electrical nerve stimulation......Page 217
8.2.4.5 Psychologic InterventionsPsychologic interventions......Page 218
8.2.5 Approach to Treatment of MVA Patients......Page 219
References......Page 220
9.1…Hypertrophic CardiomyopathyHypertrophic cardiomyopathy......Page 226
9.2…Dilated Cardiomyopathy......Page 227
9.4…MyocarditisMyocarditis......Page 229
References......Page 230
10.1…Angiogenic Treatment in Patients with Refractory Angina......Page 232
10.2.1 Prevention......Page 235
10.2.2 Mechanical Therapy......Page 236
10.2.3.2 Adenosine......Page 238
10.2.3.3 Sodium Nitroprusside......Page 239
10.2.3.6 Intracoronary Thrombolysis......Page 240
10.2.4 Ischemic Conditioning......Page 241
References......Page 242
11.1.1.2 DistalDistal and ProximalProximal Protection FiltersProtection Filters......Page 248
11.1.2 Ischaemic PreconditioningIschaemic Preconditioning......Page 249
11.1.3.3 StatinsStatins......Page 250
11.2…PreventionPrevention of CABG-Related CMDCABG-Related CMD......Page 251
11.2.1 Ischemic Conditioning......Page 252
11.2.2.1 Pharmacological Conditioning......Page 253
11.2.2.4 Sodium--Hydrogen Exchange InhibitorsSodium--Hydrogen Exchange Inhibitors......Page 254
References......Page 255
Index......Page 259