https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-22-0779/_pdf

JCS/CVIT/JCC 2023 Guideline Focused Update on Diagnosis and Treatment of Vasospastic Angina (Coronary Spastic Angina) and Coronary Microvascular Dysfunction.

Approximately one-half of patients undergoing diagnostic coronary angiography for angina have no significant coronary atherosclerotic stenosis. This clinical condition has recently been described as ischaemia with non-obstructive coronary arteries (INOCA). Coronary functional abnormalities are central to the pathogenesis of INOCA, including epicardial coronary spasm and coronary microvascular dysfunction composed of a variable combination of increased vasoconstrictive reactivity and/or reduced vasodilator function. During the last decade - in INOCA patients in particular - evidence for the prognostic impact of coronary functional abnormalities has accumulated and various non-invasive and invasive diagnostic techniques have enabled the evaluation of coronary vasomotor function in a comprehensive manner. In this review, the authors briefly summarise the recent advances in the understanding of pathophysiology and diagnosis of epicardial coronary artery spasm and coronary microvascular dysfunction.

Pathophysiology and Diagnosis of Coronary Functional Abnormalities.

ABSTRACT Binary polymer systems provide significant advantages in the preparation of materials used in biomedical applications. To highlight the importance and need of binary polymer systems in biomedical applications; utilisations of nano-carrier and fibre are discussed in detail in terms of their use as biomaterial, and their potential for further development with focus on dual and sequential drug delivery applications. On the other hand, in fibre technology, creation of binary polymer systems have been investigated using spinning processes such as electrospinning and even more recently innovated pressurised gyration. How these methods can be used to promote the mass production of binary polymer systems with various morphologies and characteristics are elucidated. The effects of different polymer materials, including solvents, mechanical properties, and the rate of degradation of polymers, are discussed. Current polymer blending systems and manufacturing processes are analysed, and technologies for biomaterials are carefully considered with up to date details.

Binary polymer systems for biomedical applications

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous group of clinical entities characterized by the common clinical evidence of myocardial infarction (MI) with non-obstructive coronary arteries on coronary angiography and without an overt cause for the MI. Platelets play a cornerstone role in the pathophysiology of MI with obstructive coronary arteries. Accordingly, antiplatelet therapy is recommended for treating patients with MI and obstructive coronary disease. However, the role of platelets in the pathophysiology of MINOCA patients is not fully defined, questioning the role of antiplatelet therapy in this setting. In this review, we will assess the role of antiplatelet therapy in MINOCA with a focus on the pathophysiology, therapeutic targets, current evidence, and future directions according to its different etiologies.

/pdf/the-role-of-antiplatelet-therapy-in-patients-with-minoca-sd4s17nr.pdf

The Role of Antiplatelet Therapy in Patients With MINOCA

JCS/CVIT/JCC 2023 guideline focused update on diagnosis and treatment of vasospastic angina (coronary spastic angina) and coronary microvascular dysfunction.

Refractory angina is an independent predictor of adverse events in patients with vasospastic angina (VSA). The aim of this study was to investigate the relationship between coronary lumen complexity and refractory symptoms in patients with VSA. Seventeen patients with VSA underwent optical coherence tomography. The patients were divided into the refractory VSA group (n = 9) and the stable VSA group (n = 8). A shoreline development index was used to assess the coronary artery lumen complexity. Shear stress was estimated using a computational fluid dynamics model. No difference was observed in the baseline characteristics between the two groups. The refractory VSA group showed the higher shoreline development index (refractory VSA 1.042 [1.017-1.188] vs stable VSA 1.003 [1.006-1.025], p = 0.036), and higher maximum medial thickness (refractory VSA 184 ± 17 μm vs stable VSA 148 ± 31 μm, p = 0.017), and higher maximum shear stress (refractory VSA 14.5 [12.1-18.8] Pa vs stable VSA 5.6 [3.0-10.5] Pa, p = 0.003). The shoreline development index positively correlates with shear stress (R2 = 0.46, P = 0.004). Increased medial thickness of the coronary arteries provokes lumen complexity and high shear stress, which might cause refractory symptoms in patients with VSA. The shoreline index could serve as a marker for irritability of the medial layer of coronary arteries and symptoms.

/pdf/coronary-artery-lumen-complexity-as-a-new-marker-for-tab2uvgbcb.pdf

Coronary artery lumen complexity as a new marker for refractory symptoms in patients with vasospastic angina.

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Coronary artery lumen complexity as a new marker for refractory symptoms in patients with vasospastic angina.