Symposium on the coronary circulation

Symposium on the Coronary Circulation URING THE PAST several years, knowledge concerning the regulation of the coronary circulation has increased enormously. Whole new areas of investigation have been developed (coronary microcirculation, free radicals and reperfusion injury, endothelial modulation of coronary vasomotion), and studies in existing areas have become more sophisticated. In addition, new technology (small Doppler catheters, improved positron emission tomography, high frequency echocardiography, cine computed tomography) has allowed more investigations of the coronary circulation to be extended to humans. Interest in coronary disease is increasing as these diseases continue to progressively dominate clinical cardiology. In my opinion, for cardiovascular physicians to gain insight into the pathophysiology of coronary disease, a broad, in-depth understanding of basic mechanisms that regulate the coronary circulation is essential. One of the purposes of this symposium is to provide the readers of Progress in Cardiovascular Diseases with a detailed review of our current understanding of basic mechanisms that regulate the coronary circulation. The reviews included encompass all essential aspects of coronary regulation and are written by internationally renowned leading investigators in the field. The articles have been extensively referenced, the text is clearly written, the synthesis of results from numerous studies is thoughtful, and the text is accompanied by a large number of carefully selected illustrations. A second purpose of the symposium is to tightly link knowledge concerning basic mechanisms that regulate the coronary circulation to specific clinical manifestations of coronary disease. For example, the observation that the coronary endothelium modulates vasoconstrictor responses of large coronary vessels to humoral substances may explain why rupture of an atherosclerotic plaque with endothelial disruption may predispose the patient to coronary spasm. Each of the articles in the symposium empha-

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sizes the clinical relevance of the basic concepts being described. The symposium will consist of 18 articles directed toward various aspects of regulation of the coronary circulation. The initial articles in the series will focus on fundamental mechanisms-coronary autoregulation (Dole), metabolic control (Olsson and Bringer), myogenic control (McHale et al), and autonomic regulation (Young et al). The second group of articles will be related to broader, but still basic topics in the field, ie, transmural myocardial perfusion (Hoffman), coronary capacitance (Mates et al), coronary endothelium (Bassenge and Busse), coronary microcirculation (Chilian et al) and the coronary collateral circulation (Schaper et al). A third group of articles relates to myocardial ischemia and infarction at both the clinical and experimental levels. This group will include a discussion of the relationship between risk and infarct area (Cobb and Chu), reperfusion injury (Becker and Ambrosio), and global myocardial ischemia (Hearse). The symposium will conclude with a series of articles on specific pathophysiologic states that influence coronary perfusion: left ventricular hypertrophy (Bache), coronary stenoses (Demer et al, Marcus et al), coronary spasm (Chierchia and Maseri), coronary bypass and percutaneous transluminal coronary angioplasty (Wilson et al), and methods of measuring coronary flow in man (White et al). The symposium will provide a great wealth of carefully synthesized information concerning basic regulatory mechanisms in the coronary circulation and how these fundamental concepts influence the clinical manifestations of coronary disease. Cardiovascular physicians who absorb the material presented will be rewarded with improved insight into the care of patients with diseases that involve the coronary circulation.

Progress in Cardiovascular Diseases, Vol XXlX, No 4 (January/February), 1987: p 291

Melvin L. Marcus, MD Guest Editor University of Iowa Iowa City

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