缺血性心血管疾病是冠心病的晚期阶段，其特征为冠状动脉阻塞或狭窄，常导致左室瘤、室间隔缺损和二尖瓣不全。身体中各种细胞分泌的细胞外囊泡（EVs）在细胞间相互作用和内在细胞调节中发挥作用。这些EVs具有脂双层膜和DNA、蛋白质、mRNA、microRNA（miRNA）和siRNA等生物组分，功用为病理生理学中的同行内分泌信号传递以及心脏稳态的维持。与具有潜在肿瘤形成性和免疫原性的干细胞移植不同，基于EV的治疗策略被提出，以满足心脏修复和再生的需求，而通过非侵入性方法检测到的循环EVs可作为珍贵的生物标志物。在本章中，我们广泛总结了源自干细胞、心肌细胞、心脏祖细胞（CPCs),内皮细胞、成纤维细胞、平滑肌细胞和免疫细胞的天然EVs和生物工程EVs的心脏保护功能。此外，还讨论了EVs作为临床诊断缺血性心血管疾病的强有力分子生物标志物的潜力，因为它们与源细胞的病理机制相同。最后，我们着重强调基于EV的治疗作为缺血性心血管疾病的细胞外治疗的生物相容性选择。© 2023. 作者，独家授权给Springer Nature Singapore Pte Ltd.

Characterized by coronary artery obstruction or stenosis, ischemic cardiovascular diseases as advanced stages of coronary heart diseases commonly lead to left ventricular aneurysm, ventricular septal defect, and mitral insufficiency. Extracellular vesicles (EVs) secreted by diverse cells in the body exert roles in cell-cell interactions and intrinsic cellular regulations. With a lipid double-layer membrane and biological components such as DNA, protein, mRNA, microRNAs (miRNA), and siRNA inside, the EVs function as paracrine signaling for the pathophysiology of ischemic cardiovascular diseases and maintenance of the cardiac homeostasis. Unlike stem cell transplantation with the potential tumorigenicity and immunogenicity, the EV-based therapeutic strategy is proposed to satisfy the demand for cardiac repair and regeneration while the circulating EVs detected by a noninvasive approach can act as precious biomarkers. In this chapter, we extensively summarize the cardioprotective functions of native EVs and bioengineered EVs released from stem cells, cardiomyocytes, cardiac progenitor cells (CPCs), endothelial cells, fibroblast, smooth muscle cells, and immune cells. In addition, the potential of EVs as robust molecule biomarkers is discussed for clinical diagnosis of ischemic cardiovascular disease, attributed to the same pathology of EVs as that of their origin. Finally, we highlight EV-based therapy as a biocompatible alternative to direct cell-based therapy for ischemic cardiovascular diseases.© 2023. The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.