This symposium has been organized by the Working Group on Coronary Pathophysiology and Microcirculation, and has been very well received by a large audience. The four lectures covered a wide spectrum of topics, spanning from very basic mechanisms, to clinical implications. The Symposium was chaired by Prof. Thomas Luscher (Zurich, CH), and Prof. Giuseppe Ambrosio (Perugia, IT).
In the first talk, Prof. Axel Pries (Berlin) presented a thorough review of the basic mechanisms which finely regulate blood flow at the microcirculatory level. It emerged that microcirculation does its job of delivering oxygen and substrates, and removing wastes, through a very complex yet interdependent network. Integration among various phenomena occurs through a fine-tuning of electrophysiologic and metabolic events.
Prof. Raffaele Bugiardini (Bologna, IT), delivered a “provocative” series of data, which convincingly showed how absence of significant coronary artery stenosis by no means equals normal conditions. There is a fairly large number of subjects (mostly women) who experience severe, and at times incapacitating, angina symptoms in spite of their showing no coronary artery lesions. The issue is even more complex when it comes to patients with angiographically normal coronary arteries suffering an acute coronary syndrome episode. These individuals will incur in a substantial number of events in the months to follow, indicating that prognosis is not so benign as previously thought.
Prof. Paolo Camici (London, UK) reviewed current methodologies to investigate microvascular function, the emphasis being on PET. He nicely documented microvascular dysfunction (portending major prognostic implications) in a number of conditions, such as hypertrophic cardiomyopathy, Fabry’s disease, aortic stenosis, characterised by microvascular remodeling.
Finally, Prof. Andreas Zehier (Frankfurt, DE), reviewed a number of relevant studies who established the prognostic value of microvascular function in patients with coronary artery disease, and provided data suggesting that endothelial progenitor cells might be the next frontier.
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