- Prof. Gaetano Antonio Lanza, MD
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Cardiologia, Largo A. Gemelli, Rome, Italy.
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Special Issue Introduction
Cardiac ischemic syndromes have substantially been attributed for a long time to obstructive atherosclerotic coronary artery plaques and their complications. A large number of studies, however, have shown that up to 60% of patients with symptoms compatible with stable angina and 30% of those presenting with a clinical picture of an acute coronary syndrome (mainly, non-ST segment elevation acute coronary syndrome) present normal or near-normal coronary arteries. While epicardial coronary artery spasm can be responsible for myocardial ischemia in a subset of these patients, a large number of studies have shown that coronary microvascular dysfunction (CMD) is the pathophysiologic mechanism of ischemic symptoms in a sizeable proportion of these patients. Several works in the past 40 years have indeed demonstrated the presence of abnormal coronary microvascular dilatation or increased coronary microvascular constriction/spasm in most patients. Accordingly, the identification of these patients has major implications for their correct management and treatment. While some progresses has been made in this field, several aspects remain to be clarified, including the most reliable diagnostic approach to well characterize CMD in individual patients, the real prognostic implications of CMD in the various clinical settings in which it is involved and the treatment of patients with recurrent angina symptoms despite full anti-ischemic therapy. This special issue of Vessel Plus has two main objectives: 1) to provide the readers, through thoughtful review articles, with a comprehensive presentation of the current knowledge about the role of CMD in determining cardiac ischemic syndromes and the implications that this has in the diagnostic, prognostic and therapeutic approach to patients; 2) to stimulate researchers, in particular young researchers, to present data through original articles that may add significant insights on unresolved issues regarding the pathophysiologic, as well as diagnostic, prognostic and therapeutic aspects of cardiac ischemic syndromes related to CMD.
KeywordsAcetylcholine test, adenosine test, angina with non-obstructed coronary arteries, cold pressor test, coronary blood flow, coronary flow reserve, coronary microcirculation, coronary microvascular constriction, coronary microvascular dysfunction, coronary microvascular resistance, coronary microvascular spasm, endothelium-dependent coronary vasodilatation, endothelium-independent coronary
Submission Deadline31 Mar 2021