Coronary microvascular dysfunction – a unifying pathophysiological mechanism of non-obstructive myocardial ischemia?

Bakgrund:

Approximately 90% of the cardiac blood volume resides in the microvasculature. It has become evident that obstructive epicardial disease is not the only cause of myocardial ischemia as microvascular dysfunction has been linked to angina, comorbidity and mortality. This highlights that myocardial ischemia is a physiological continuum of focal and diffuse disease, however major knowledge gaps of microvascular dysfunction exists.

This project intends to reveal pathophysiological knowledge of microvascular dysfunction by investigating both cardiac and non-cardiac diseases. With a unique set-up of state-of-the-art cardiac imaging, the presence of microvascular dysfunction will be studied in both ischemic and non-ischemic disease with the underlying hypothesis that microvascular dysfunction is a unifying pathophysiological mechanism of non-obstructive myocardial ischemia.

Målsättning:

The overall purpose of the project is to provide new fundamental insights necessary for improving the clinical diagnosis of CMD, and identify mechanisms for therapeutic choices through comprehensive assessment of CMD in different clinical populations. Arbetsplan:

Different patient categories with both cardiac and non-cardiac disease will be investigated using state-of-the-art stress perfusion magnetic resonance to reveal the presence of microvascular dysfunction in a broad patientpopulation. Specific patients categories include myocardial infarction with normal coronaries, Takotsubo syndrome, Wilson's disease and the new disease Covid-19.

Betydelse:

The proposed project uses highly original quantitative perfusion mapping by CMR to address major knowledge gaps regarding CMD and its pathophysiological mechanisms in both cardiac and non-cardiac diseases. The project goals are well defined and are highly relevant for a large group of patients that are currently underdiagnosed and without specific treatment.

Furthermore, the project aim to elucidate potential sex differences in CMD. The projects are highly feasible for our research group with both broad and deep interdisciplinary medical and technical competence with the potential to improve cardiac care. With the innovative use of highly advanced CMR technology for combined scientific and clinical benefit, knowledge on CMD in separate clinical population will add to the current body of knowledge regarding the coronary microvasculature and the mechanisms for pathology in non-obstructive myocardial ischemia.