Modern Concepts of Fibromuscular Dysplasia of the Coronary Arteries
Abstract
Fibromuscular dysplasia of the coronary arteries is a rare non-atherosclerotic and non-inflammatory vascular lesion that is asymptomatic until serious complications develop: stenosis, dissection, rupture, sudden cardiac death. Since there are no long-term numerous clinical observations of patients with fibromuscular dysplasia of the coronary arteries, recommendations have not been developed for diagnosing and treating the disease, which often manifests with acute coronary syndrome. In 2014, the European Consensus was published, and in 2019, the first international consensus document on the diagnosis and treatment of fibromuscular dysplasia with lesions of vessels from different regions (renal, cerebrovascular, coronary, and others). The documents state that the development of fibromuscular dysplasia of the coronary arteries considers the participation of the PHACTR1 gene mutation and the transcriptional activity of the EDN1 gene, smoking, prolonged exertion of the vascular wall, and possibly female sex hormones. In the case of acute coronary syndrome, the most informative diagnostic method is computed tomography with angiography, which reveals a smooth narrowing of the lumen in the middle or distal section in the epicardial artery, often due to intramural hematoma, and also finds dissection, spasm, and tortuous vessel. Additional diagnostic methods ‒ intravascular ultrasound and optical coherence tomography allow differentiation of fibromuscular dysplasia with atherosclerosis of the coronary artery, vasculitis, and other diseases. The choice of treatment tactics for fibromuscular dysplasia of the coronary arteries depends on the severity of the clinical manifestations ‒ conservative medical treatment and interventional methods are used.
About the Author
E. L. Trisvetova
Belarusian State Medical University
Belarus
Belarus
MD, PhD, Professor, 2nd Chair of Internal Diseases
Dzerzhinsky prosp. 83, Minsk, 220116 Republic of Belarus
References
1. Persu A., Giavarini A., Touze E., et al. European consensus on the diagnosis and management of fibromuscular dysplasia. J Hypertens. 2014;32(7):1367-78. DOI:10.1097/HJH.0000000000000213.
2. Gornik H.L., Persu A., Adlam D., et al. First International Consensus on the diagnosis and management of fibromuscular dysplasia. J Hypertens. 2019;37(2):229-52. DOI:10.1177/1358863X18821816.
3. Leadbetter W.F., Burkland C.E. Hypertension in unilateral renal disease. J Urol. 1938;39:611-26.
4. McCormack L.J., Hazard J.B., Poutasse E.F. Obstructive lesions of the renal artery associated with remediable hypertension. Am J Pathol.1958;34:582.
5. Harrison E.G., Jr McCormack L.J. Pathologic classification of renal arterial disease in renovascular hypertension. Mayo Clin Proc. 1971;46:161-7.
6. Hill L.D., Antonius J.I. Arterial dysplasia: an important surgical lesion. Arch Surg. 1965;90:585-95.
7. Shivapour D.M., Erwin P., Kim E.S.H. Epidemiology of fibromuscular dysplasia: A review of the literature. Vasc Med. 2016;21(4):376-81. DOI:10.1177/1358863X16637913.
8. Olin J.W., Gornik H.L., Bacharach J.M., et al. Fibromuscular dysplasia: State of the science and critical unanswered questions: A scientific statement from the American Heart Association. Circulation. 2014;129(9):1048-78. DOI:10.1161/01.cir.0000442577.96802.8c.
9. Plouin P.F., Baguet J.P., Thony F., et al. High prevalence of multiple arterial bed lesions in patients with fibromuscular dysplasia: The ARCADIA Registry (Assessment of Renal and Cervical Artery Dysplasia). Hypertension. 2017;70(3):652-58. DOI:10.1161/HYPERTENSIONAHA.117.09539.
10. Biando C., Klimusina J., Suerder D., et al. Coronary fibromuscular dysplasia: A rare cause of familial acute coronary syndrome. Case report and review of the literature. Cardiovascular Medicine. 2014;17(10):283-8.
11. Zack F., Terpe H., Hammer U., et al. Fibromuscular dysplasia of coronary arteries as a rare cause of death. Int J Legal Med. 1996;108(4):215-8.
12. Huizar J.F., Awasthi A., Kozman H. Fibromuscular dysplasia and acute myocardial infarction: Evidence for a unique clinical and angiographicpattern. J Invasive Cardiol. 2006;18:E99-101.
13. Kuzyk J., Boiko O., Stetsko T. Fibromuscular Dysplasia of the Coronary Arteries: A Case Report and Review of the Literature. Turk Patoloji Derg. 2018;34(3):269-73. DOI:10.5146/tjpath.2015.01341.
14. Saw J., Aymong E., Sedlak T., et al. Spontaneous coronary artery dissection: association with predisposing arteriopathies and precipitating stressors and cardiovascular outcomes. Circ Cardiovasc Interv. 2014;7(5):645-55. DOI:10.1161/CIRCINTERVENTIONS.114.001760.
15. Eleid M.F., Guddeti R.R., Tweet M.S., et al. Coronary artery tortuosity in spontaneous coronary artery dissection: Angiographic characteristics and clinical implications. Circ Cardiovasc Interv. 2014;7(5):656-62. DOI:10.1161/CIRCINTERVENTIONS.114.001676.
16. Kiando S.R., Tucker N.R., Castro-Vega L.J., et al. PHACTR1 Is a Genetic Susceptibility Locus for Fibromuscular Dysplasia Supporting Its Complex Genetic Pattern of Inheritance. PLoS Genet. 2016;12(10):e1006367. DOI:10.1371/journal.pgen.1006367.
17. Adlam D., Olson T.M., Combaret N., et al. Association of the PHACTR1/EDN1 Genetic Locus With Spontaneous Coronary Artery Dissection. J Am Coll Cardiol. 2019;73(1):58-66. DOI:10.1016/j.jacc.2018.09.085.
18. Di Monaco S., Georges A., Lengelé J.P., et al. Genomics of Fibromuscular Dysplasia. Int J Mol Sci. 2018;19(5):1526. DOI:10.3390/ijms19051526.
19. Lüscher T.F., Lie J.T., Stanson A.W., et al. Arterial fibromuscular dysplasia. Mayo Clin. Proc. 1987;62:931-52. DOI:10.1016/S0025-6196(12)65051-4.
20. O’Connor S., Gornik H.L., Froehlich J.B., et al. Smoking and adverse outcomes in fibromuscular dysplasia: U.S. Registry report. J Am Coll Cardiol. 2016;67:1750-51.
21. Shimabukuro M. A new plausible link between lysophosphatidylcholine, TGF-β, and fibromuscular dysplasia. J AtherosclerThromb. 2016;23(6):665-7. DOI:10.5551/jat.ED040.
22. Michelis K.C., Olin J.W., Kadian-Dodov D., et al. Coronary Artery Manifestations of Fibromuscular Dysplasia. J Am Coll Cardiol. 2014;64(10):1033-46. DOI:10.1016/j.jacc.2014.07.014
23. Jing H.L., Hu B.J. Sudden death caused by stricture of the sinus node artery. Am J Forensic Med Pathol. 1997;18(4):360-2. DOI:10.1097/00000433-199712000-00009.
24. Thygesen K., Joseph S., Alpert J.S., et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J. 2019;40(3):237-69. DOI:10.1093/eurheartj/ehy462.
25. Olin J.W. Expanding Clinical Phenotype of Fibromuscular Dysplasia Hypertension. 2017;70(3):488-89. DOI:10.1161/HYPERTENSIONAHA.117.09646.
26. Hayes N.S., Kim E.S.H., Jacqueline Saw J., et al. Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association. Circulation. 2018;137:e523-e557. DOI:10.1161/CIR.0000000000000564.
27. Saw J. Coronary angiogram classification of spontaneous coronary artery dissection. Catheter Cardiovasc Interv. 2014;84(7):1115-22. DOI:10.1002/ccd.25293.
28. Saw J., Bezerra H., Gornik H.L., et al. Angiographic and intracoronary manifestations of coronary fibromuscular dysplasia. Circulation. 2016;133(16):1548-59. DOI:10.1161/CIRCULATIONAHA.115.020282.
29. Alfonso F., Paulo M., Gonzalo N., et al. Diagnosis of spontaneous coronary artery dissection by optical coherence tomography. J Am Coll Cardiol. 2012;59(12):1073-79. DOI:10.1016/j.jacc.2011.08.082.
30. Malfait F., Francomano C., Byers P., et al. The 2017 international classification of the Ehlers-Danlossyndromes. Am J Med Genet C Semin Med Genet. 2017;175(1):8-26. DOI:10.1002/ajmg.c.31552.
31. Nakamura M., Yajima J., Oikawa Y., et al. Vascular Ehlers-Danlos syndrome-all three coronary artery spontaneous dissections. J Cardiol. 2009;53(3):458-62. DOI:10.1016/j.jjcc.2008.09.007.
32. Terao C., Yoshifuji H., Mimori T. Recent advances in Takayasu arteritis. Int J Rheum Dis. 2014;17(3):238-47. DOI:10.1111/1756-185X.12309.
33. Alibaz-Oner F., Aydin S.Z., Direskeneli H. Recent advances in Takayasu’s arteritis. Eur J Rheumatol. 2015;2(1):24-30. DOI:10.5152/eurjrheumatol.2015.0060.
34. Basso C., Marra M.P., Thiene G. Cocaine and the heart: more than just coronary disease. Heart. 2011;97(24):1995-96. DOI:10.1136/heartjnl-2011-300736.
35. Lanza G.A., Sestito A., Sgueglia G.A., et al. Current clinical features, diagnostic assessment and prognostic determinants of patients with variant angina. Int J Cardiol. 2007;118(1):41-7. DOI:10.1016/j.ijcard.2006.06.016.
36. Alegria J.R., Herrmann J., Holmes D.R. Jr, et al. Myocardial bridging. Eur Heart J. 2005;26(12):1159-68. DOI:10.1093/eurheartj/ehi203.
37. Kadakia R.S., Link M.S., Dominic P., et al. Sudden cardiac death in nonischemic cardiomyopathy. Prog Cardiovasc Dis. 2019 May 7. pii: S0033-0620(19)30077-5. DOI:10.1016/j.pcad.2019.05.002.
38. Williams B., Mancia G., Spiering W., et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(3):3021-3104. DOI:10.1093/eurheartj/ehy339.
39. Ibanez B., James S., Agewall S., et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-177. DOI:10.1093/eurheartj/ehx393.
40. Kadian-Dodov D., Gornik H.L., Gu X., et al. Dissection and aneurysm in patients with fibromuscular dysplasia: findings from the U.S. Registry for FMD. J Am Coll Cardiol. 2016;68(2):176-85. DOI:10.1016/j.jacc.2016.04.044.
Review
For citations:
Trisvetova E.L. Modern Concepts of Fibromuscular Dysplasia of the Coronary Arteries. Rational Pharmacotherapy in Cardiology. 2019;15(3):431-438. (In Russ.) https://doi.org/10.20996/1819-6446-2019-15-3-431-438
Views: 535
Email this article 