Coronary Microcirculation and Ischemic Heart Disease, Today

This article summarizes several contributions on the coronary microcirculation. Many of the participant authors belong to the Working Group on Coronary Pathophysiology and Microcirculation of European Society of Cardiology. These contributions explored a variety of topics pertaining to coronary microvascular physiology and pathophysiology. The latest methodologies that are being used to investigate the coronary microvasculature, including myocardial contrast echocardiography, fractional flow reserve and and instantaneous wave free ratio, are discussed. Advances in the mechanisms of dysfunction of the coronary microcirculation-for example, enhanced arginase activity and production of free radicals by dyslipidemia or hyperhomocysteinemia and its myogenic and flow-dependent responses--are reported. The articles touched on the relation of the microcirculation to clinically important conditions, such as the coronary no reflow phenomenon and offered recommendations for future research in important areas, such as angiogenesis and restoration of the microvascular network. This research is providing new ways to explore abnormalities of myocardial perfusion and its relationship with post infarction myocardial damage, an area of inquiry that until recently has been limited to examination of coronary pressure-flow relationships using doppler wire-based measures