ESC Working Group on Coronary Pathophysiology and Microcirculation position paper on 'coronary microvascular...

Area of Science:

• Cardiology
• Vascular Biology
• Internal Medicine

Background:

• Myocardial ischemia often results from atherosclerosis, but a subset of patients experience it without obstructive epicardial coronary artery disease.
• Coronary microvascular abnormalities are increasingly recognized as a primary cause of ischemia in patients with apparently normal coronary arteries.
• Microvascular dysfunction is linked to early atherosclerosis, myocardial hypertrophy, and heart failure.

Purpose of the Study:

• To update the understanding of the pathophysiological consequences of cardiac microvascular dysfunction.
• To review the role of cardiovascular risk factors and comorbidities in microcirculatory dysfunction.
• To highlight the clinical significance and implications of coronary microvascular dysfunction.

Main Methods:

• Review of experimental and clinical evidence on coronary microcirculation.
• Analysis of the association between cardiovascular risk factors, comorbidities, and microvascular dysfunction.
• Synthesis of current knowledge on the clinical impact of microvascular dysfunction.

Main Results:

• Abnormalities in the coronary microcirculation are a significant cause of myocardial ischemia.
• Microvascular dysfunction can precede or occur independently of epicardial coronary stenosis.
• Cardiovascular risk factors and comorbidities contribute to the development of microvascular dysfunction.

Conclusions:

• Recognizing the clinical importance of coronary microvascular dysfunction is crucial for advancing cardiovascular medicine.
• Further research into microvascular dysfunction will facilitate the development of novel interventions.
• Early detection and risk stratification based on microvascular health align with precision medicine principles.