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Updated: Apr 22, 2026

Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
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Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction

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Coronary microvascular dysfunction: mechanisms and functional assessment

Paolo G Camici1, Giulia d'Amati2, Ornella Rimoldi3

  • 1Vita Salute University and Scientific Institute San Raffaele, Via Olgettina, 58, 20132 Milano, Italy.

Nature Reviews. Cardiology
|October 15, 2014
PubMed

Insights

Coronary microvascular dysfunction is an emerging cause of myocardial ischemia. Advanced imaging and invasive methods can assess this dysfunction, offering new insights into heart disease mechanisms.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Diagnostic Imaging

Background:

  • Epicardial coronary artery disease has long been linked to angina and myocardial infarction.
  • Coronary microvascular dysfunction (CMD) is increasingly recognized as a significant mechanism of myocardial ischemia.
  • The coronary microvasculature, comprising vessels <300 μm, plays a critical role in regulating myocardial blood flow.

Purpose of the Study:

  • To review the pathophysiology and prognostic implications of coronary microvascular dysfunction.
  • To discuss invasive and noninvasive techniques for assessing coronary microvascular function.
  • To highlight the insights gained from advanced assessment methods in various clinical conditions.

Main Methods:

  • Invasive assessment of Doppler-derived coronary blood flow velocity reserve.
  • Noninvasive imaging techniques to evaluate myocardial blood flow and flow reserve.
  • Calculation of microcirculatory resistance indexes during coronary catheterization.

Main Results:

  • Coronary microvascular dysfunction is a key contributor to myocardial ischemia.
  • Various techniques offer insights into microvascular function, despite limitations.
  • Advanced assessment methods have revealed the pathophysiological role of CMD.

Conclusions:

  • Coronary microvascular dysfunction is a crucial factor in myocardial ischemia with prognostic significance.
  • Assessing coronary microvascular function requires specialized invasive and noninvasive techniques.
  • Understanding CMD through these advanced methods provides novel insights into ischemic heart disease.

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