The pathogenic role of coronary microvascular dysfunction in the setting of other cardiac or systemic conditions

Area of Science:

• Cardiology
• Vascular Biology
• Internal Medicine

Background:

• Coronary microvascular dysfunction (CMD) is increasingly recognized for its role in various cardiovascular and systemic diseases.
• It contributes pathologically beyond its established role in microvascular angina.
• Understanding CMD's involvement in diverse conditions is crucial for comprehensive patient care.

Purpose of the Study:

• To review the pathogenic role of CMD in conditions such as diabetes mellitus, obesity, hypertensive pregnancy disorders, rheumatic disorders, chronic kidney disease, hypertrophic cardiomyopathy, and aortic valve stenosis.
• To highlight that CMD arises from disease-specific alterations in the coronary microcirculation.
• To emphasize the early detectability and prognostic significance of CMD.

Main Methods:

• Systematic literature review of studies investigating coronary microvascular dysfunction.
• Analysis of pathogenic mechanisms linking CMD to various systemic and cardiac diseases.
• Synthesis of evidence on the early detection and clinical implications of CMD.

Main Results:

• CMD is implicated in the pathogenesis of diabetes mellitus, obesity, hypertensive pregnancy disorders, rheumatic diseases, chronic kidney disease, hypertrophic cardiomyopathy, and aortic valve stenosis.
• Alterations in coronary microcirculation structure, function, or dynamics are associated with these primary conditions.
• CMD can be an early indicator of disease, preceding overt myocardial ischemia and signaling increased cardiovascular risk.

Conclusions:

• Coronary microvascular dysfunction is a significant pathogenic factor in a wide spectrum of cardiac and systemic conditions.
• Early identification of CMD is vital for risk stratification and timely intervention in affected patients.
• Further research into the mechanisms and management of CMD across different disease states is warranted.