Small Vessel Disease

Ischemic Heart Disease (IHD), stroke, and dementia are leading causes of death and disability worldwide,notably affecting aging populations. The public health burden related to chest pain is substantial and the epidemiology of IHD because of large‐vessel coronary atherosclerosis is well documented. By contrast, the epidemiology of Small‐Vessel Disease (SVD) in the heart is less well established. Cohort studies indicate that the underlying cause of anginal chest pain may be SVD in more than 1 in 3 of all‐comers with stable symptoms. IHD because of SVD associates with vascular risk factors, such as hypertension and female sex.

The vascular anatomy of the heart and brain is similar in that conduit arteries are distributed on the surface of these organs with tissue perfusion achieved through deep penetrating arteries. In the heart, SVD involves the deep penetrating coronary arterioles and the subendocardial plexus of microvessels. The clinical sequelae of SVD in the heart include stable and acute coronary syndromes and heart failure in the longer term. SVD in the brain mainly involves small subcortical cerebral arteries. Occlusion of 1 of these vessels may result in a clinical stroke syndrome known as a lacunar syndrome

Methods

We undertook a literature search for original research articles including information on SVD in both heart and brain. The search used PubMed and covered the period January 1, 1973 to May 31, 2018. We searched for Human studies in English that included these terms in the Title or Abstract. This search yielded 513 hits and 2 researchers independently screened the abstracts. Eighteen abstracts were selected and the outputs were discussed by 4 investigators. By consensus, we identified 9 research articles that provided information on SVD in both the heart and the brain, and 1 other on microvascular disease in the kidney and brain. The search was updated on October 12, 2018 and no new original articles fulfilling these criteria were identified.

Neuroimaging of SVD

The damage caused by SVD impacts both deep gray and white matter structures in the brain. While CT scans can reveal the presence of SVD, the ideal method for visualizing the full spectrum of SVD is structural MRI. This includes FLAIR, T1 and T2-weighted as well as gradient echo MRI sequences. More recently, whole-brain magnetic resonance spectroscopy has also been used to study markers of brain inflammation. These brain imaging modalities reveal in SVD recent small subcortical infarcts, hyperintensities in the periventricular and deep white matter, lacunes, microbleeds, and enlarged perivascular spaces, located predominantly in the basal ganglia and the subcortical white matter. As well, the blood-brain barrier is impaired in small vessel disease.

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Regards           

Meria Den       

Managing Editor         

Stroke Research & Therapy