Assessment and pathophysiology of microvascular disease: recent progress and clinical implications

Abstract The development of novel, non-invasive techniques and standardization of protocols to assess microvascular dysfunction have elucidated the key role of microvascular changes in the evolution of cardiovascular (CV) damage, and their capacity to predict an increased risk of adverse events. The...

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Published inEuropean heart journal Vol. 42; no. 26; pp. 2590 - 2604
Main Authors Masi, Stefano, Rizzoni, Damiano, Taddei, Stefano, Widmer, Robert Jay, Montezano, Augusto C, Lüscher, Thomas F, Schiffrin, Ernesto L, Touyz, Rhian M, Paneni, Francesco, Lerman, Amir, Lanza, Gaetano A, Virdis, Agostino
Format Journal Article
LanguageEnglish
Published Oxford University Press 08.07.2021
Subjects
Clinical Review
Editor's Choice
Clinical manifestations
Epigenetics
Oxidative stress
Microvascular disease
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Summary:Abstract The development of novel, non-invasive techniques and standardization of protocols to assess microvascular dysfunction have elucidated the key role of microvascular changes in the evolution of cardiovascular (CV) damage, and their capacity to predict an increased risk of adverse events. These technical advances parallel with the development of novel biological assays that enabled the ex vivo identification of pathways promoting microvascular dysfunction, providing novel potential treatment targets for preventing cerebral-CV disease. In this article, we provide an update of diagnostic testing strategies to detect and characterize microvascular dysfunction and suggestions on how to standardize and maximize the information obtained from each microvascular assay. We examine emerging data highlighting the significance of microvascular dysfunction in the development CV disease manifestations. Finally, we summarize the pathophysiology of microvascular dysfunction emphasizing the role of oxidative stress and its regulation by epigenetic mechanisms, which might represent potential targets for novel interventions beyond conventional approaches, representing a new frontier in CV disease reduction. Graphical Abstract
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Stefano Masi, Damiano Rizzoni, Gaetano A. Lanza and Agostino Virdis contributed equally to the manuscript.
ISSN:0195-668X
1522-9645
DOI:10.1093/eurheartj/ehaa857