Our mission is to become a worldwide reference for education in the field for all professionals involved in the process to disseminate knowledge & skills of Acute Cardiovascular Care.
Our mission is to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular imaging in Europe.
Our mission is to promote excellence in research, practice, education and policy in cardiovascular health, primary and secondary prevention.
Our mission is to reduce the burden of cardiovascular disease in Europe through percutaneous cardiovascular interventions.
Our mission is to improve the quality of life of the population by reducing the impact of cardiac rhythm disturbances and reduce sudden cardiac death.
Our mission is to improve quality of life and longevity, through better prevention, diagnosis and treatment of heart failure, including the establishment of networks for its management, education and research.
The ESC Working Groups' goal is to stimulate and disseminate scientific knowledge in different fields of cardiology.
The ESC Councils' goal is to share knowledge among medical professionals practising in specific cardiology domains.
OUR MISSION: TO REDUCE THE BURDEN OF CARDIOVASCULAR DISEASE
Dr. Axel Radlach Pries,
This session was initiated by the ESC-Working Group on Coronary Pathophysiology and Microcirculation. As stated in the first presentation by Eric de Bakker (Amsterdam, NL), coronary microvessels with diameters below about 300 µm are the site of perfusion control and regulation. They not only exhibit short term diameter changes by adjustment of tone, but also long term adaptation by modification of wall structure. Evidence was presented that the vessel wall translates sustained changes of tone into corresponding changes of structure: if vessel diameter is reduced for several days by a high level of tone, this simulates an inward remodelling. In this process, protein cross linking by tissue glutaminase plays a central role. Obviously, these reactions can be very relevant in generating and augmenting high peripheral resistance in hypertension.The second presentation (Cor de Wit, Luebeck, DE) gave a comprehensive overview of vascular remodelling reactions in the presence of proximal coronary obstruction. These changes lead to a structural increase in microvascular flow resistance – which will limit flow restoration after angioplasty. Dr. Akos Koller (Pecs, HU) discussed remodelling events in type 2 diabetes. Here, inward remodelling can be aggravated due to multiple changes in the vascular responses, including an increased myogenic and a reduced endothelial response. The latter is linked to reduced nitric oxide (NO) availability due to the effects of oxidative stress on tetra-hydro-biopterin (THB4) a co-factor of the NO-Synthase.The symposium was concluded by an outlook into clinical presentation and management of patients with coronary microvascular dysfunction (Juan-Carlos Kaski, London, UK). This condition leads to a significant decrease in quality of life and requires a very flexible clinical approach due to its multicausal pathophysiology. Treatment options range from physical exercise schemes to vasculotropic medication including statins and ACE inhibition.
Mechanisms and clinical implications of coronary microvascular remodelling
© 2017 European Society of Cardiology. All rights reserved