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Estudio fisiológico invasivo de la vasorreactividad coronaria y la microcirculación
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Las imágenes no invasivas resultan opciones válidas para detectar la cardiopatía isquémica. La evaluación directa de las respuestas microcirculatorias coronarias a estímulos vasodilatadores y la evaluación de los trastornos vasomotores representan ventajas de los procedimientos diagnósticos intervencionistas. La relevancia funcional de las alteraciones en la microcirculación coronaria y los mecanismos independientes del endotelio de la disfunción coronaria microvascular se pueden apreciar durante el estudio de la macrocirculación coronaria. La administración de estímulos inductores de vasorreactividad investiga los mecanismos dependientes del endotelio de la disfunción coronaria microvascular y los trastornos del tono vasomotor epicárdico. Los procedimientos de diagnóstico intervencionista diferencian endotipos subyacentes en cardiopatía isquémica y guían un enfoque de terapia personalizada, según la respuesta fisiológica del paciente.
El estudio de la microcirculación coronaria se puede estimar dentro del mismo procedimiento, y su valor diagnóstico sirve para interpretar los resultados de la intervención coronaria percutánea. El presente documento resume el estado actual del conocimiento sobre el estudio de la microcirculación coronaria y sus mecanismos independientes del endotelio en la disfunción coronaria microvascular. Además, expone las ideas básicas para una correcta interpretación de sus resultados en el laboratorio de hemodinámica.
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