Pathophysiology and Molecular Mechanisms of Coronary Artery Spasm
Rho-kinase plays a central role in the pathogenesis of coronary artery spasm caused by vascular smooth muscle cell (VSMC) hypercontraction. Rho-kinase belongs to the family of serine/threonine kinases and is an important downstream effector of the small G
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Coronary Vasomotion Abnormalities
Hiroaki Shimokawa Editor
Coronary Vasomotion Abnormalities
Editor Hiroaki Shimokawa Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine Sendai Miyagi Japan
ISBN 978-981-15-7593-8 ISBN 978-981-15-7594-5 (eBook) https://doi.org/10.1007/978-981-15-7594-5 © Springer Nature Singapore Pte Ltd. 2021 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore
Preface
Stable coronary artery disease (CAD) is mainly caused by the various combinations of the three mechanisms, including epicardial organic coronary stenosis, epicardial coronary artery spasm, and coronary microvascular dysfunction (CMD). The representative manifestations of those three mechanisms are effort angina, vasospastic angina (VSA), and microvascular angina (MVA), respectively. Among them, VSA and MVA represent typical manifestations of coronary functional abnormalities. To date, much attention has been paid to the first mechanism, epicardial organic coronary stenosis, leading to the successful developments of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). However, it is also widely known that approximately 40% of patients with obstructive CAD still suffer from persistent/recurrent angina even after complete revascularization with PCI and/or CABG. Also, the prevalence of angina with nonobstructive CAD has been rapidly increasing worldwide, approximately 70% in women and 50% in men. Furthermore, to the surprise of the world, recently, the ISCHEMIA Trial has convincingly demonstrated that revascularization strategy with PCI or CABG has no prognostic benefit in patients with stable CAD with proven
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