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Functional characteristics of the coronary microcirculation

Funktionelle Charakterisierung der koronaren Mikrozirkulation

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Abstract

For over 50 years, it has been recognized that coronary blood flow is precisely matched to cardiac metabolism. The interactions which govern this matching remain unknown. In the current review, 3 specific aspects of coronary flow regulation will be discussed: Specialization of function in different microvascular domains, influence of cardiac region on microvascular function and the interactions of vasoactive agents in control of coronary blood flow.

Each level of the coronary microcirculation is affected by different physical and chemical forces within the heart. These forces place special demands on these vessels and are in turn met by specialized vasodilator responses, including metabolic and flow-mediated vasodilation. Perfusion of the heart is also profoundly affected by the region perfused. The endocardium is affected by forces, notably cardiac contraction, in a different manner than the epicardium. Thus, the microcirculation has specialized to meet these demands. Finally, the factors determining microvascular tone appear to be coordinated such that the loss of any individual dilator, such as nitric oxide, can be compensated for by the increased contribution of another, such as adenosine. This interplay may serve to protect the heart from ischemia during the early phases of coronary vascular disease when individual dilators may be impaired.

Zusammenfassung

Seit über 50 Jahren ist die Beziehung zwischen koronarer Durchblutung und Myokardmetabolismus bekannt. Die Interaktion zwischen den einzelnen Kontrollsystemen zur Regulation der Koronardurchblutung, die funktionelle Bedeutung der mikrovaskulären Strombahn und der Anfluß der Myokardregion auf die mikrovaskuläre Funktion sind jedoch weitgehend ungeklärt. Drei wesentliche Mechanismen existieren, die den Koronartonus regulieren: 1. die metabolische Regulation, 2. die flußabhängige Regulation, 3. die Autoregulation. Die physiologische Anpassung des mikrovaskulären Tonus ist eng verbunden mit dem kardialen Sauerstoffverbrauch. Eine Steigerung des myokardialen Sauerstoff-verbrauchs führt zu einer Dilatation der mikrovaskulären Gefäße. Dies ist bekannt als metabolische Dilatation oder funktionelle Hyperämie. Die schnelle Stimulation steigert den myokardialen Sauerstoffverbrauch. Die Reaktion der mikrovaskulären Gefäße ist heterogen. Die kleinen Arteriolen sind besonders verantwortlich für die koronare Flußsteigerung während der metabolischen Dilatation. Adenosin induziert eine Dilatation der kleinen und größeren Arteriolen. Die Regulation der epikardialen Koronarterienweite ist bekannt. Die Dilatation geht verloren, wenn akut oder chronisch NO blockiert wird, während der Anstieg der Koronardurchblutung als Reaktion auf metabolische Effekte oder pharmakologische Eingriffe erhalten ist. Neuere Untersuchungen weisen darauf hin, daß die flußabhängige Dilatation nicht nur die epikardialen Gefäße, sondern auch die koronare Mikrozirkulation erreicht. Die Autoregulation ist definiert als die intrinsische Eigenschaft, den Koronarfluß bei Änderungen des koronaren Perfusionsdruckes unabhängig von Änderungen des Metabolismus aufrechtzuerhalten. Als Antwort auf physiologische Eingriffe reagiert das koronare mikrovaskuläre Gebiet heterogen und nicht einheitlich. Das atriale mikrovaskuläre System ist geringer ausgeprägt als das ventrikuläre System. Die Dilatation nach Gabe von Adenosin, Bradykinin und Substanz P ist ähnlich. Als Folge findet sich eine einigermaßen gleichmäßige Perfusion aller Myokardregionen. Die großen Unterschiede in bezug auf den Koronarfluß, die in verschiedenen Regionen bei reduziertem Perfusionsdruck beobachtet werden, sind hauptsächlich abhängig von physikalischen Faktoren, wie die Kontraktion des Myokards.

NO spielt eine zentrale Rolle in der Regulation des koronaren vaskulären Tonus. Wichtig ist, daß verschiedene potentielle Dilatatoren zur Verfügung stehen, wenn selbst NO gehemmt wird.

Multiple Mediatoren formen ein interaktives Netzwerk, das das Herz vor den Schädigungen, induziert durch Ischämie, schützt und die Anpassung an Belastungen ermöglicht. Diese Mediatoren spielen wahrscheinlich eine wichtige Rolle in der Frühphase der koronaren Herzerkrankung.

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  1. Department of Physiology, Medical College of Wisconsin, 8701 Watertown Plank Road, 53226, Milwaukee, WI, USA

    David W. Stepp Ph. D.

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  1. Daphne Merkus
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Merkus, D., Chilian, W.M. & Stepp, D.W. Functional characteristics of the coronary microcirculation. Herz 24, 496–508 (1999). https://doi.org/10.1007/BF03044220

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