Istituto di Fisiologia Clinica     
L'Abbate A., Sambuceti G., Haunsų S., Schneider-Eicke J. Methods for evaluating coronary microvasculature in humans. In: european heart journal, vol. 20 pp. 1300 - 1313. oxford journals, 1999.
Abnormalities in myocardial blood flow, despite angiographically normal coronary arteries, have been reported in a large number of cardiovascular disorders such as congestive heart failure, hypertensive heart disease, dilated and hypertrophic cardiomyopathies and syndrome X. More recently, similar abnormalities have also been reported in patients with ischaemic heart disease in myocardial regions remote from coronary stenosis. To explain these findings, three main factors have been considered: perturbation in central haemodynamics leading to a relative decrease in coronary driving pressure, particularly in subendocardial layers[1]; myocardial hypertrophy leading to both microvascular compression and to a relative discrepancy between the number of vessels and the volume of the myocardial cells[2] and, finally, spasm in large coronary arteries[3]. However, considerable evidence has now been collected challenging this interpretation. Flow abnormalities, often associated with clinical and electrocardiographic signs of ischaemia, have been observed in the absence of any of the factors mentioned above[4]. For this reason, an hypothesis of the existence of primary abnormalities at the level of the coronary microcirculation— either anatomical or functional — has been put forward by several authors[4,5]. To date, evaluation of the coronary microcirculation in patients is hampered by a number of methodological limitations. As a consequence, although the coronary microvasculature is suspected of being involved in a large number of clinical syndromes, its nature and mechanisms remain largely speculative. In this paper, we will not review the large number of observations supporting the hypothesis of microvascular involvement in different cardiovascular diseases[6] but rather discuss the available techniques for studying microcirculation in the clinical setting. More specifically, this paper will try to identify the most appropriate technique to answer specific research questions about the anatomy and function of the coronary microcirculation. Table 1 outlines the overall structure of the paper, listing the research questions and the relative methodologies available that can be used to answer those questions.
URL: http://eurheartj.oxfordjournals.org/cgi/reprint/20/18/1300
Subject Coronary

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