Recomandările Asociaţiei Europene de Ecocardiografie privind ...

Mihaela Ţârlea
Microcirculaţia coronariană
4 ani - ”mult prea mare pentru o persoană cu coronare
angiografi c normale” (Pepine) 50 .
Modalitatea cea mai evidentă și accesibilă explorării
sub care se manifestă afectarea microcirculatorie este
disfuncţia endotelială la nivelul vaselor microcirculaţiei.
În acest sens, evaluarea triggerilor bolii vasculare
va trebui să fi e făcută nu prin studiul morbidităţii și
mortalităţii ci a unor obiective intermediare ţinând de
expresia fenotipului vascular 79 .
Deși posibilitatea măsurării neinvazive a funcţiei
endoteliale a transformat deja înţelegerea evoluţiei fenomenelor
aterosclerotice, studii ulterioare sunt necesare
atât asupra mecanismelor ce conduc la alterarea
microcirculaţiei cât și la standardizarea metodelor de
diagnostic, mai ales neinvaziv, metoda nefi ind încă
adaptată screening-ului general sau luării de decizii în
cazuri individuale 79 . Grupuri de lucru precum Endothelin
and Endothelial factors of the European Society Of
Hypertension (2005) 69 și Working Group on Coronary
Pathophysiology and Microcirculation of the European
Society of Cardiology (ESC) (2008) 80 se străduiesc să
sta bilească standardele pentru explorarea neinvazivă a
micro circulaţiei.
În viitor se poate anticipa că endoteliul va deveni o
ţintă directă a intervenţiilor diagnostice și terapeutice
atât precoce, în evoluţia leziunilor aterosclerotice către
expresie clinică cât și în cazul coexistenţei leziunilor
micro și macrocirculaţiei, în vederea prevenirii complicaţiilor
și evoluţiilor nefavorabile și ameliorării prognosticului
bolii coronariene 47 .
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