New insights into the pathophysiology, classification, and diagnosis of coronary microvascular dysfunction

Area of Science:

• Cardiology
• Vascular Biology
• Diagnostic Imaging

Background:

• The coronary microvasculature is crucial for regulating coronary blood flow and myocardial oxygen supply.
• Coronary microvascular dysfunction (CMVD) is increasingly recognized as an independent predictor of adverse cardiovascular outcomes.
• Understanding CMVD is challenging due to the complexity of microvascular anatomy and functional pathways.

Purpose of the Study:

• To review the current understanding of coronary microvascular dysfunction (CMVD).
• To discuss the diagnostic challenges and limitations of current assessment tools for CMVD.
• To highlight the clinical significance and unmet therapeutic needs in managing CMVD.

Main Methods:

• Review of existing literature on coronary microvasculature and CMVD.
• Discussion of invasive and noninvasive diagnostic modalities for assessing CMVD.
• Analysis of current clinical classifications and treatment recommendations for CMVD.

Main Results:

• CMVD is prevalent across various cardiac conditions, with or without epicardial coronary artery disease.
• Invasive assessment of coronary blood flow and microvascular resistance remains the gold standard.
• Despite recognized poor outcomes, targeted therapies for CMVD are currently unavailable.

Conclusions:

• CMVD is a significant clinical entity associated with poor prognosis in cardiovascular disease.
• Current management focuses on symptom relief and risk factor modification due to a lack of specific therapies.
• There is a critical need for robust clinical trials to evaluate targeted treatment strategies for CMVD.