Sweat the small stuff: The human microvasculature and heart disease

Area of Science:

• Cardiovascular Science
• Microvascular Medicine
• Cardiac Pathophysiology

Background:

• The coronary microvasculature's role is shifting from solely regulating blood flow to directly influencing the myocardium.
• Coronary microvascular dysfunction (CMD) is linked to various cardiovascular conditions, including heart failure with preserved ejection fraction and hypertrophic cardiomyopathy.
• CMD is a significant predictor of cardiovascular events, irrespective of atherosclerotic cardiovascular disease presence.

Purpose of the Study:

• To review the evolving understanding of the coronary microvasculature's direct role in cardiac health.
• To explore the clinical consequences and underlying mechanisms of CMD.
• To discuss diagnostic and risk stratification methods for coronary microvasculature assessment.

Main Methods:

• Review of current literature on coronary microvasculature and CMD.
• Discussion of pathophysiological concepts related to resistance arterioles.
• Examination of invasive and non-invasive assessment techniques.

Main Results:

• CMD plays a direct role in myocardial health beyond perfusion regulation.
• CMD precedes large artery atherosclerosis and is associated with specific heart conditions.
• CMD is a strong predictor of adverse cardiovascular outcomes.

Conclusions:

• The coronary microvasculature is a critical factor in cardiovascular disease pathogenesis.
• CMD presents a potential target for novel therapeutic strategies.
• Accurate assessment of the coronary microvasculature is crucial for diagnosis and risk stratification.