[Coronary microvascular dysfunction : Clinical aspects, diagnosis and therapy]

Area of Science:

• Cardiology
• Vascular Biology
• Myocardial Pathophysiology

Background:

• Coronary microvascular dysfunction (CMD) involves structural and functional alterations in small coronary vessels (<500 µm).
• Mechanisms underlying CMD are diverse, overlapping, and not fully understood, with potential links to inflammation, estrogen deficiency, and genetics.
• CMD is a common, underdiagnosed cause of angina pectoris in patients lacking obstructive epicardial coronary artery disease.

Purpose of the Study:

• To summarize the current understanding of coronary microvascular dysfunction (CMD).
• To highlight diagnostic approaches for CMD.
• To discuss the clinical implications and future research directions for CMD.

Main Methods:

• Diagnosis of CMD can be achieved through non-invasive methods like coronary computed tomography (CT) angiography combined with cardiac stress magnetic resonance imaging (MRI) or positron emission tomography (PET).
• Invasive coronary vasomotor assessment is also a viable diagnostic option.
• Current treatment recommendations are based on limited evidence, with European Society of Cardiology (ESC) guidelines suggesting acetylsalicylic acid (ASS), statins, beta-blockers, and/or calcium channel blockers.

Main Results:

• Patients with CMD face an elevated annual risk of approximately 1.7% for coronary events and mortality.
• CMD is associated with increased morbidity, leading to frequent clinical encounters and emergency hospital admissions.
• There is a significant lack of evidence regarding the efficacy of pharmacological treatments for CMD.

Conclusions:

• CMD represents a significant clinical challenge due to its complex pathophysiology and underdiagnosis.
• Improved characterization of CMD mechanisms is crucial for developing effective, targeted therapeutic strategies.
• Further clinical research is essential to advance the management and improve outcomes for patients with CMD.