engleski

Coronary Microcirculatory Dysfunction in Human Cardiomyopathies - A Pathologic and Pathophysiologic Review

Cardiomyopathies are a heterogeneous group of diseases of the myocardium. The term cardiomyopathy involves a wide range of pathogenic mechanisms that affect the structural and functional states of cardiomyocytes, extravascular tissues and coronary vasculature, including both epicardial coronary arteries and the microcirculation. In the developed phase, cardiomyopathies present with various clinical symptoms: dyspnea, chest pain, palpitations, swelling of the extremities, arrhythmias and sudden death. Due to the heterogeneity of cardiomyopathic patterns and symptoms, their diagnosis and therapies are a great challenge. Despite extensive research, the relation between the structural and functional abnormalities of the myocardium and the coronary circulation are still not well understood in the various forms of cardiomyopathy. The main pathological characteristics of cardiomyopathy and the coronary microcirculation develop in a progressive manner due to 1) genetic- immunologicsystemic factors ; 2) comorbidities with endothelial, myogenic, metabolic and inflammatory changes ; 3) aging-induced arteriosclerosis, and 4) myocardial fibrosis in different forms of cardiomyopathy. The aim of this review is to summarize the most important common pathological features and/or adaptations of the coronary microcirculation in various types of cardiomyopathies and to integrate the present understanding of the underlying pathophysiological mechanisms responsible for the development of various types of cardiomyopathies. Although microvascular dysfunction is present and contributes to cardiac dysfunction and the potential outcome of disease, the current therapeutic approaches are not specific for the given types of cardiomyopathy.

dilated cardiomyopathy ; ischemia ; hypertrophic cardiomyopathy ; restrictive cardiomyopathy ; aging ; coronary microvessels ; nitric oxide availability

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