The Central Nervous System and Psychosocial Factors in Primary Microvascular Angina
Patients diagnosed with ischemia without obstructive coronary artery disease (INOCA) comprise the group of patients with primary microvascular angina (MVA). The pathophysiology underlying ischemia and angina is multifaceted. Differences in vascular tone, collateralization, environmental and psychoso...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-05-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.896042/full |
| _version_ | 1828748003148562432 |
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| author | Mattia Cattaneo Mattia Cattaneo Mattia Cattaneo Geza Halasz Magdalena Maria Cattaneo Magdalena Maria Cattaneo Adel Younes Camilla Gallino Camilla Gallino Isabella Sudano Isabella Sudano Augusto Gallino Augusto Gallino Augusto Gallino |
| author_facet | Mattia Cattaneo Mattia Cattaneo Mattia Cattaneo Geza Halasz Magdalena Maria Cattaneo Magdalena Maria Cattaneo Adel Younes Camilla Gallino Camilla Gallino Isabella Sudano Isabella Sudano Augusto Gallino Augusto Gallino Augusto Gallino |
| author_sort | Mattia Cattaneo |
| collection | DOAJ |
| description | Patients diagnosed with ischemia without obstructive coronary artery disease (INOCA) comprise the group of patients with primary microvascular angina (MVA). The pathophysiology underlying ischemia and angina is multifaceted. Differences in vascular tone, collateralization, environmental and psychosocial factors, pain thresholds, and cardiac innervation seem to contribute to clinical manifestations. There is evidence suggesting potential interactions between the clinical manifestations of MVA and non-cardiac conditions such as abnormal function of the central autonomic network (CAN) in the central nervous system (CNS), pain modulation pathways, and psychological, psychiatric, and social conditions. A few unconventional non-pharmacological and pharmacological techniques targeting these psychosocial conditions and modulating the CNS pathways have been proposed to improve symptoms and quality of life. Most of these unconventional approaches have shown encouraging results. However, these results are overall characterized by low levels of evidence both in observational studies and interventional trials. Awareness of the importance of microvascular dysfunction and MVA is gradually growing in the scientific community. Nonetheless, therapeutic success remains frustratingly low in clinical practice so far. This should promote basic and clinical research in this relevant cardiovascular field investigating, both pharmacological and non-pharmacological interventions. Standardization of definitions, clear pathophysiological-directed inclusion criteria, crossover design, adequate sample size, and mid-term follow-up through multicenter randomized trials are mandatory for future study in this field. |
| first_indexed | 2024-04-14T04:53:31Z |
| format | Article |
| id | doaj.art-dbec7b5303874a2ba5e72f9c218d5896 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-14T04:53:31Z |
| publishDate | 2022-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-dbec7b5303874a2ba5e72f9c218d58962022-12-22T02:11:13ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-05-01910.3389/fcvm.2022.896042896042The Central Nervous System and Psychosocial Factors in Primary Microvascular AnginaMattia Cattaneo0Mattia Cattaneo1Mattia Cattaneo2Geza Halasz3Magdalena Maria Cattaneo4Magdalena Maria Cattaneo5Adel Younes6Camilla Gallino7Camilla Gallino8Isabella Sudano9Isabella Sudano10Augusto Gallino11Augusto Gallino12Augusto Gallino13Cardiology Department, Istituto Cardiocentro Ticino, Lugano, SwitzerlandHuman Medicine Department, Università della Svizzera italiana, Lugano, SwitzerlandCardiovascular Research Unit, Hospital of San Giovanni, Bellinzona, SwitzerlandHeart Failure Unit, Guglielmo da Saliceto Hospital, Azienda unità sanitaria locale (AUSL) Piacenza, University of Parma, Parma, ItalyHuman Medicine Department, Università della Svizzera italiana, Lugano, SwitzerlandCardiovascular Research Unit, Hospital of San Giovanni, Bellinzona, SwitzerlandCardiology Department, Istituto Cardiocentro Ticino, Lugano, SwitzerlandHuman Medicine Department, Università della Svizzera italiana, Lugano, SwitzerlandCardiovascular Research Unit, Hospital of San Giovanni, Bellinzona, SwitzerlandHuman Medicine Department, University of Zurich, Zurich, SwitzerlandCardiology Department, University Hospital, University Heart Center Zurich, Zurich, SwitzerlandHuman Medicine Department, Università della Svizzera italiana, Lugano, SwitzerlandCardiovascular Research Unit, Hospital of San Giovanni, Bellinzona, SwitzerlandHuman Medicine Department, University of Zurich, Zurich, SwitzerlandPatients diagnosed with ischemia without obstructive coronary artery disease (INOCA) comprise the group of patients with primary microvascular angina (MVA). The pathophysiology underlying ischemia and angina is multifaceted. Differences in vascular tone, collateralization, environmental and psychosocial factors, pain thresholds, and cardiac innervation seem to contribute to clinical manifestations. There is evidence suggesting potential interactions between the clinical manifestations of MVA and non-cardiac conditions such as abnormal function of the central autonomic network (CAN) in the central nervous system (CNS), pain modulation pathways, and psychological, psychiatric, and social conditions. A few unconventional non-pharmacological and pharmacological techniques targeting these psychosocial conditions and modulating the CNS pathways have been proposed to improve symptoms and quality of life. Most of these unconventional approaches have shown encouraging results. However, these results are overall characterized by low levels of evidence both in observational studies and interventional trials. Awareness of the importance of microvascular dysfunction and MVA is gradually growing in the scientific community. Nonetheless, therapeutic success remains frustratingly low in clinical practice so far. This should promote basic and clinical research in this relevant cardiovascular field investigating, both pharmacological and non-pharmacological interventions. Standardization of definitions, clear pathophysiological-directed inclusion criteria, crossover design, adequate sample size, and mid-term follow-up through multicenter randomized trials are mandatory for future study in this field.https://www.frontiersin.org/articles/10.3389/fcvm.2022.896042/fullprimary microvascular anginacentral nervous systempsychosocial factorsunconventional interventionsspinal cord stimulationpain modulation centers |
| spellingShingle | Mattia Cattaneo Mattia Cattaneo Mattia Cattaneo Geza Halasz Magdalena Maria Cattaneo Magdalena Maria Cattaneo Adel Younes Camilla Gallino Camilla Gallino Isabella Sudano Isabella Sudano Augusto Gallino Augusto Gallino Augusto Gallino The Central Nervous System and Psychosocial Factors in Primary Microvascular Angina Frontiers in Cardiovascular Medicine primary microvascular angina central nervous system psychosocial factors unconventional interventions spinal cord stimulation pain modulation centers |
| title | The Central Nervous System and Psychosocial Factors in Primary Microvascular Angina |
| title_full | The Central Nervous System and Psychosocial Factors in Primary Microvascular Angina |
| title_fullStr | The Central Nervous System and Psychosocial Factors in Primary Microvascular Angina |
| title_full_unstemmed | The Central Nervous System and Psychosocial Factors in Primary Microvascular Angina |
| title_short | The Central Nervous System and Psychosocial Factors in Primary Microvascular Angina |
| title_sort | central nervous system and psychosocial factors in primary microvascular angina |
| topic | primary microvascular angina central nervous system psychosocial factors unconventional interventions spinal cord stimulation pain modulation centers |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.896042/full |
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