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REVIEW article

Front. Cardiovasc. Med.
Sec. Cardiovascular Imaging
Volume 11 - 2024 | doi: 10.3389/fcvm.2024.1372703
This article is part of the Research Topic Evaluation of Coronary Microvascular Dysfunction Based on Cardiovascular Imaging View all 8 articles

CORONARY MICROVASCULAR DYSFUNCTION IN AUTOIMMUNE RHEUMATIC DISEASES: BEYOND CORONARY FLOW VELOCITY RESERVE

Provisionally accepted
Annagrazia Cecere Annagrazia Cecere 1Martina Perazzolo Marra Martina Perazzolo Marra 1Elisabetta Zanatta Elisabetta Zanatta 2Giovanni Civieri Giovanni Civieri 1Sabino Iliceto Sabino Iliceto 1Francesco Tona Francesco Tona 1,3*
  • 1 Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine and Surgery, University of Padua, Padua, Veneto, Italy
  • 2 Department of Medicine, School of Medicine and Surgery, University of Padua, Padua, Veneto, Italy
  • 3 University of Padua, Padua, Italy

The final, formatted version of the article will be published soon.

    Autoimmune rheumatic diseases (ARDs) are a heterogeneous group of disorders characterized by an inappropriate immune reactivity against different body tissues. Patients affected by ARDs present an increased cardiovascular morbidity and mortality, that significantly impacts on the long-term prognosis. Endothelial dysfunction, inflammation, oxidative stress and autoimmunity are strictly involved in atherosclerosis progression and coronary microvascular dysfunction (CMD), both responsible for the increased cardiovascular risk. CMD represents the inability of the coronary microvasculature to respond with vasodilation to the increased cardiac metabolic requests and it could be assessed by non-invasive and invasive imaging tests. Coronary flow velocity reserve assessed by echocardiography demonstrated to correctly identify ARDs patients with CMD. However, stress cardiac magnetic resonance (CMR) accurately assesses myocardial ischemia, perfusion and viability in ARDs patients. Myocardial perfusion reserve index (MPRI) is a robust semi-quantitative imaging marker, representing the vasodilatory capacity of the coronary microcirculation in response to a vasodilator stress. In absence of significant coronary stenosis, ARDs patients revealed a reduced MPRI in comparison with general population, regardless the presence of myocardial fibrosis.Identification of CMD in asymptomatic patients could be crucial to precociously start targeted medical therapy, avoiding major adverse cardiac events in this clinical setting. This review aims to summarize the current evidence regarding CMD in ARDs patients, focusing on the role of stress CMR and the promising myocardial perfusion analysis.

    Keywords: Coronary microvascular dysfunction, Autoimmune rheumatic diseases, Coronary flow reserve, cardiac magnetic resonance, Coronary flow velocity reserve

    Received: 18 Jan 2024; Accepted: 31 Jul 2024.

    Copyright: © 2024 Cecere, Perazzolo Marra, Zanatta, Civieri, Iliceto and Tona. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Francesco Tona, University of Padua, Padua, Italy

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.