Document Detail

Obstructive coronary atherosclerosis and ischemic heart disease: an elusive link!
MedLine Citation:
PMID:  22954239     Owner:  NLM     Status:  MEDLINE    
In the current pathophysiological model of chronic ischemic heart disease (IHD), myocardial ischemia and exertional angina are caused by obstructive atherosclerotic plaque, and the clinical management of IHD is centered on the identification and removal of the stenosis. Although this approach has been in place for years, several lines of evidence, including poor prognostic impact, suggest that this direct relationship may present an oversimplified view of IHD. Indeed, a large number of studies have found that IHD can occur in the presence or absence of obstructive coronary artery disease and that atherosclerosis is just 1 element in a complex multifactorial pathophysiological process that includes inflammation, microvascular coronary dysfunction, endothelial dysfunction, thrombosis, and angiogenesis. Furthermore, the high recurrence rates underscore the fact that removing stenosis in patients with stable IHD does not address the underlying pathological mechanisms that lead to the progression of nonculprit lesions. The model proposed herein shifts the focus away from obstructive epicardial coronary atherosclerosis and centers it on the microvasculature and myocardial cell where the ischemia is taking place. If the myocardial cell is placed at the center of the model, all the potential pathological inputs can be considered, and strategies that protect the cardiomyocytes from ischemic damage, regardless of the causative mechanism, can be developed.
Mario Marzilli; C Noel Bairey Merz; William E Boden; Robert O Bonow; Paola G Capozza; William M Chilian; Anthony N DeMaria; Giacinta Guarini; Alda Huqi; Doralisa Morrone; Manesh R Patel; William S Weintraub
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.; Review    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  60     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-09-07     Completed Date:  2012-11-13     Revised Date:  2013-02-27    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  951-6     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Cardiothoracic Department, Division of Cardiology, University Hospital of Pisa, Italy.
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MeSH Terms
Atherosclerosis / complications*
Coronary Disease / complications*
Coronary Stenosis / complications
Myocardial Ischemia / classification,  etiology*
Comment In:
J Am Coll Cardiol. 2013 Jan 22;61(3):388   [PMID:  23328616 ]
J Am Coll Cardiol. 2013 Jan 22;61(3):387-8   [PMID:  23328614 ]
J Am Coll Cardiol. 2012 Sep 11;60(11):957-9   [PMID:  22954240 ]

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