Microvascular heart involvement in systemic autoimmune diseases: The purinergic pathway and therapeutic insights from the biology of the diseases

Elisa Gremese, Enrico De Lorenzis, Silvia Laura Bosello, Gianfranco Ferraccioli, Michael Tuahier Nurmohamed, Gianfranco Sinagra

Risultato della ricerca: Contributo in rivistaArticolo in rivista

3 Citazioni (Scopus)

Abstract

Heart involvement – often asymptomatic – is largely underestimated in patients with systemic autoimmune diseases (SADs). Cardiovascular events are more frequent in patients with SADs compared to the general population, owing to the consequences of inflammation and autoimmunity and to the high prevalence of traditional risk factors. Coronary microvascular disease (CMD) is a form of cardiac involvement that is increasingly recognised yet still largely neglected. CMD, the incapacity of the coronary microvascular tree to dilate when myocardial oxygen demand increases or when there is a microvascular spasm (or subclinical myocarditis), is increasingly reported because of the widespread use of new cardiac imaging tools, even in a subclinical phase. The assessment of myocardial coronary flow reserve (CFR) emerged as the most effective clinical tool to detect microvascular damage. The potential causes of microvascular damage, molecular and cellular inflammation along with a pathological CD39-CD73 axis, need always to be considered because data show that they play a role in the occurrence of acute coronary syndromes, heart failure and arrhythmias, even in the early asymptomatic stage. Data suggest that controlling disease activity by means of methotrexate, biologic drugs, antimalarial medications, statins and aspirin, according to indication, might reduce the cardiovascular risk related to macrovascular and microvascular damage in most patients with SADs, provided that they are used early and timely to control diseases. The need of new biomarkers and a careful assessment of myocardial CFR emerged as the most effective clinical tool to detect microvascular damage.
Lingua originaleEnglish
pagine (da-a)317-324
RivistaAUTOIMMUNITY REVIEWS
Volume18
DOI
Stato di pubblicazionePubblicato - 2019

Keywords

  • Cardiac magnetic resonance imaging
  • Coronary artery disease
  • Coronary microvascular disease
  • Immunology
  • Immunology and Allergy
  • Myocarditis
  • Purinergic signalling
  • Systemic autoimmune diseases

Fingerprint Entra nei temi di ricerca di 'Microvascular heart involvement in systemic autoimmune diseases: The purinergic pathway and therapeutic insights from the biology of the diseases'. Insieme formano una fingerprint unica.

Cita questo