La malattia del microcircolo coronarico nella disfunzione ventricolare sinistra: dai modelli sperimentali alla clinica

Coronary vascular microcirculation plays a major role in the pathogenesis of left ventricular dysfunction as well as in the development of heart failure. Coronary microcirculation includes all the vessels which contribute to provide resistance to coronary flow. It represents the district where coronary circulation blood flow is regulated to ensure that each structural and functional cardiac component receives the proper amount of oxygen and metabolic substrates through the capillary network. Coronary microcirculation is fundamental for myocardial function which largely depends on the ratio between energetic metabolites received from coronary circulation and their utilization by the myocytes. Alterations in coronary microvascular circulation which limit myocardial perfusion can cause repetitive ischemic events leading to left ventricular dysfunction in several ischemic and non ischemic cardiomyopathies as the idiopathic dilated cardiomyopathy. To date, mechanisms underlying microvascular dysfunction are not completely understood and experimental animal models are employed to study alterations which may cause microcirculation impairment. These animals models are unique tools to identify new therapeutic targets, to test new drug therapies for the treatment of left ventricular dysfunction as well as its progression towards overt heart failure.