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Coronary artery endothelial dysfunction: Basic concepts

Frank W Sellke, MD
Emile R Mohler III, MD
Amir Lerman, MD
R Jay Widmer, MD, PhD
Filippo Crea, MD
Section Editor
Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
Deputy Editor
Gordon M Saperia, MD, FACC


The coronary arterial circulation, which consists of conductance and resistance vessels, plays a major role in the delivery of blood to the myocardium. The endothelium is the layer of cells that lines these blood vessels. This layer maintains blood vessel (vascular) tone, regulates hemostasis, acts as barrier to potentially toxic materials, and regulates inflammation. Notably, the metabolic regulation of coronary blood flow that takes place at the site of resistance vessels allows a perfect matching between oxygen supply and demand. The increase of blood flow in the presence of an increase of oxygen demand is mainly mediated by the release of tiny amounts of free oxygen radicals.

Endothelial dysfunction is the inability of the endothelium to optimally perform one or more of these functions. Dysfunction of the endothelium is the principal determinant of chronic microvascular dysfunction but also may occur in the larger conduit arteries, especially when atherosclerosis is present. The principal clinical consequence of microcirculatory dysfunction is myocardial ischemia but can also include vascular thrombosis, increased vascular permeability, and diastolic changes in the myocardium. Endothelial dysfunction plays a key role in determining myocardial ischemia in all clinical manifestations of ischemic heart disease. Furthermore, the decrement in the noninvasive measurement of peripheral endothelial function has been shown in a large systematic review and meta-analysis encompassing over 17,000 patients to double the cardiovascular risk in moderate-risk individuals [1].

This topic will focus on basic concepts of normal endothelial function and dysfunction. More clinical aspects are discussed separately. (See "Coronary artery endothelial dysfunction: Clinical aspects".)


The endothelium is one of the largest organs in the body and it interacts with nearly every other organ or organ system [2,3]. It is a single (mono) layer of cells serving multiple purposes:

Maintenance of hemostasis, the balance between thrombosis and clotting


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Literature review current through: Sep 2016. | This topic last updated: May 16, 2016.
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