overview of Coronary Microvascular Diseases.pptx

overview of Coronary Microvascular Diseases

1. CONVENTIONAL THERAPY Anti- Anginal Medications : Beta-blockers Calcium Channel Blockers Nitrates Ranolazine ACE Inhibitors and ARBs Statins Emerging Therapies Ivabradine Trimetazidine SGLT2 Inhibitors Interventional Therapies Enhanced External Counterpulsation Coronary Sinus Reducer Ongoing Research Gene Therapy Stem Cell Therapy Bairey Merz , C.N., Pepine , C.J., Shimokawa , H. and Berry, C., 2020. Treatment of coronary microvascular dysfunction. Cardiovascular research , 116 (4), pp.856-870.

2. GENE AND CELL-BASED THERAPIES Gene and cell-based therapies—including cellular injections with bone-marrow-derived CD34+ cells paracrine factors, or growth and differentiation factors, from transplanted cells and/or reactive immune cells modify healing processes. Development of novel small-molecule pharmacological strategies derived from these paracrine factors to stimulate endogenous mechanisms and provide alternatives to current therapies for CMD. Bairey Merz , C.N., Pepine , C.J., Shimokawa , H. and Berry, C., 2020. Treatment of coronary microvascular dysfunction. Cardiovascular research , 116 (4), pp.856-870.

3. Bairey Merz , C.N., Pepine , C.J., Shimokawa , H. and Berry, C., 2020. Treatment of coronary microvascular dysfunction. Cardiovascular research , 116 (4), pp.856-870.

4. Schematic diagram of the referred therapeutic interventions for clinical management of coronary microvascular dysfunction, including their respective mechanism of action. Conventional pharmacotherapy options are included in blue circles, whereas alternative and novel pharmacological approaches are included in red ones. Abbreviations: A2R, Adenosine receptor 2; ACE-Is, Angiotensin converting enzyme inhibitors; cAMP , cyclic adenosine monophosphate; CBF, Coronary blood flow; cGMP , cyclic guanosine monophosphate; ET-1, Endothelin-1; IL- 1, Interleukin-1; NPY, Neuropeptide Y; SGLT2i, Sodium-glucose transport protein 2 inhibitors; TP, Thrombospondin ; TXA2S, Thromboxane A2 synthase; VSMC, Vascular smooth muscle cell Created with BioRender.com Sofia Lamprou , Theano Dermintzoglou , Dimitris Christos Kleitsiotis , Ioanna Andreadou . “Coronary microvascular dysfunction: Implications in ischemic heart disease and therapeutic interventions”. Conditioning Medicine 2022. 5(1): 30-50.

5. Treatment of Coronary Microvascular Disease Cholesterol medication to improve cholesterol levels. Blood pressure medications to lower high blood pressure and decrease the heart's workload. Antiplatelet medication to help prevent blood clots. Medications to relax blood vessels including beta blockers, calcium channel blockers and nitroglycerin . Nitroglycerin to treat chest pain. American Heart Association

6. Prevention of Coronary Microvascular Disease Manage blood pressure Control cholesterol Reduce blood sugar Get active Eat better Lose or manage weight Stop smoking  American Heart Association https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain/coronary-microvascular-disease-mvd

7. Treatment strategies for CMD. CMD, Coronary microvascular dysfunction; ACEI, Angiotensin converter enzyme inhibitor; ARB, Angiotensin receptor blocker; CCB, calcium channel blockers; SGLT2, sodium‑glucose cotransporter 2 Yang, Z., Liu, Y., Li, Z., Feng, S., Lin, S., Ge , Z., Fan, Y., Wang, Y., Wang, X. and Mao, J., 2023. Coronary microvascular dysfunction and cardiovascular disease: Pathogenesis, associations and treatment strategies. Biomedicine & Pharmacotherapy , 164 , p.115011.

8. Treatment strategies Lifestyle management Risk factor management Modern drug therapies MDT- Antiplatelet and lipid-lowering therapies MDT-Myocardial ischaemia and angina pectoris therapies MDT- New drugs MDT- Natural products MDT- Nondrug therapies Yang, Z., Liu, Y., Li, Z., Feng, S., Lin, S., Ge , Z., Fan, Y., Wang, Y., Wang, X. and Mao, J., 2023. Coronary microvascular dysfunction and cardiovascular disease: Pathogenesis, associations and treatment strategies. Biomedicine & Pharmacotherapy , 164 , p.115011.

9. Class of Intervention Study Design n Major Inclusion Criteria Primary Endpoints Main Findings Aerobic interval CUT-IT trial 70 Obese patients with CFR assessed by ↑ CFR after aerobic training and Randomized clinical trial (12 weeks stable CAD transthoracic Doppler interval training and after weight loss aerobic interval training or low- echocardiography on low energy diet without energy diet) the LAD significant between- group difference Smoking cessation Rooks et al 360 360 Smoking and nonsmoking CFR assessed as CFR was significantly   Twins Heart Study   middle-aged male twins response to lower in smokers   Investigation of psychological,     adenosine with PET compared with   behavioral and biological risk       nonsmokers (P < 0.01)   factors for subclinical           cardiovascular disease using twins         Exercise training Hambrecht et al 19 Obstructive CAD and a Changes in vascular ↑ endothelium- Randomized clinical trial (exercise- noncritical stenosis in diameter in response dependent vasodilatation training group n 1⁄4 10 and control another coronary vessel to the intracoronary with exercise training group n 1⁄4 9) with signs of endothelial infusion of increasing (P < 0.01) dysfunction (defined as doses of constriction or no change acetylcholine in response to acetylcholine)