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
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