Is the peripheral microcirculation a window into the human coronary microvasculature?

• Published in: Journal of molecular and cellular cardiology Vol. 193; pp. 67 - 77
• Main Authors: SenthilKumar, Gopika, Hammond, Stephen T., Zirgibel, Zachary, Cohen, Katie E., Beyer, Andreas M., Freed, Julie K.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.08.2024
• Subjects: Animals; Cardiovascular Diseases - physiopathology; Coronary; Coronary Circulation; Coronary Vessels - physiopathology; Endothelium; Endothelium, Vascular - metabolism; Humans; Microcirculation; Microvasculature; Microvessels; Translational; INOCA; eNOS; CAD; Translational; HFpEF; Endothelium; CVD; MACE; MINOCA; ROS; Coronary; Microvasculature; CMD; FMD; MPRI; Endo-PAT; TS
• ISSN: 0022-2828; 1095-8584; 1095-8584
• DOI: 10.1016/j.yjmcc.2024.06.002

An increasing body of evidence suggests a pivotal role for the microvasculature in the development of cardiovascular disease. A dysfunctional coronary microvascular network, specifically within endothelial cells—the inner most cell layer of vessels—is considered a strong, independent risk factor for future major adverse cardiac events. However, challenges exist with evaluating this critical vascular bed, as many of the currently available techniques are highly invasive and cost prohibitive. The more easily accessible peripheral microcirculation has surfaced as a potential surrogate in which to study mechanisms of coronary microvascular dysfunction and likewise may be used to predict poor cardiovascular outcomes. In this review, we critically evaluate a variety of prognostic, physiological, and mechanistic studies in humans to answer whether the peripheral microcirculation can add insight into coronary microvascular health. A conceptual framework is proposed that the health of the endothelium specifically may link the coronary and peripheral microvascular beds. This is supported by evidence showing a correlation between human coronary and peripheral endothelial function in vivo. Although not a replacement for investigating and understanding coronary microvascular function, the microvascular endothelium from the periphery responds similarly to (patho)physiological stress and may be leveraged to explore potential therapeutic pathways to mitigate stress-induced damage. [Display omitted] •Peripheral microvascular endothelial dysfunction has emerged as a strong independent predictor of poor cardiovascular outcomes.•For the special issue on Microvessels in the Heart, we pose the question of whether peripheral microvessels can be leveraged to answer key questions regarding coronary endothelial health.•Finally, we explore the endothelium as the potential link between the coronary and endothelial vascular beds and identify remaining important and unanswered questions.