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Endotheliale Funktionsstörung bei Patienten mit akutem Koronarsyndrom

Assessment of endothelial dysfunction in acute coronary syndromes

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Zusammenfassung

In der Pathogenese der koronaren Herzerkrankung spielen vor allem eine verstärkte Vasokonstriktion, eine gesteigerte Interaktion zwischen Thrombozyten und Gefäßwand sowie eine Monozytenmigration in die Subintima mit Lipideinlagerung und die Migration von Muskelzellen eine entscheidende Rolle. Akute Koronarsyndrome (akuter Myokardinfarkt und instabile Angina pectoris) sind durch Plaqueruptur oder erosion, Vasokonstriktion sowie Aktivierung von Thrombozyten und Gerinnung charakterisiert. Die Endotheldysfunktion ist ein wesentlicher Baustein in der Pathophysiologie des akuten Koronarsyndroms und der koronaren Herzerkrankung. Akute koronare Syndrome können durch Entzündungsmechanismen ausgelöst werden.

Insbesondere im Hinblick auf ein zeitlich begrenztes reversibles Geschehen der eingeschränkten Endothelfunktion sowie des akuten Koronarsyndroms stellen die wenig invasiven Methoden zum Monitoring der Endothelfunktion ein potentielles Werkzeug in der Kontrolle dieser Hochrisikopatienten und ihrer Therapie dar.

Abstract

Increased vasoconstriction, activation of platelet vessel wall interaction and invasion of monocytes into the subintima as well as vascular smooth muscle cell proliferation play a fundamental role in the pathogenesis of coronary artery disease. Acute coronary syndromes such as myocardial infarction and unstable angina pectoris are characterized by plaque rupture or erosion, activation of platelets and the coagulation system and vasoconstriction. Endothelial dysfunction may be one of the underlying mechanisms linking coronary artery disease and acute coronary syndromes. Both of these are often temporarily limited.

Therefore, „non-invasive examination” of endothelial function by venous occlusion plethysmography or high resolution ultrasound might be useful for monitoring high-risk patients.

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  1. Medizinische Klinik IV, Abteilung Kardiologie, Johann-Wolfgang-Goethe-Universität, Theodor-Stern-Kai 7, D-60590, Frankfurt

    Stephan Fichtlscherer & Andreas M. Zeiher

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Fichtlscherer, S., Zeiher, A.M. Endotheliale Funktionsstörung bei Patienten mit akutem Koronarsyndrom. Herz 24, 534–543 (1999). https://doi.org/10.1007/BF03044225

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