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Coronary microvascular disease: current concepts of pathophysiology, diagnosis and management

Aish Sinha1, Haseeb Rahman1, Divaka Perera1

  • 1The BHF Centre of Excellence and the NIHR Biomedical Research Centre at the School of Cardiovascular Medicine and Sciences, King's College London, London, UK.

Cardiovascular Endocrinology & Metabolism
|February 26, 2021
PubMed

Insights

Coronary microvascular disease (CMD) affects 30% of angina patients, increasing risks. Early diagnosis and tailored management of CMD, guided by physiological testing, improve outcomes, though treatments are still evolving.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Imaging

Background:

  • Coronary microvascular disease (CMD) impacts a significant portion of angina patients, correlating with higher morbidity and mortality.
  • Current understanding of CMD pathophysiology and diagnostic methods has advanced considerably.
  • Physiological testing-guided management of CMD shows superior results compared to empirical approaches.

Purpose of the Study:

  • To review recent advancements in understanding the pathophysiology of coronary microvascular disease.
  • To discuss current diagnostic modalities for CMD, including invasive and noninvasive tests.
  • To explore existing therapeutic strategies and future directions for managing CMD.

Main Methods:

  • Literature review of recent studies on coronary microvascular disease.
  • Analysis of diagnostic testing modalities for CMD.
  • Evaluation of current and emerging treatment strategies for CMD.

Main Results:

  • Improved understanding of CMD pathophysiology is available.
  • Diagnostic tools for CMD have become more refined.
  • Evidence supports physiological testing for guiding CMD management.

Conclusions:

  • CMD is a significant clinical issue in patients with angina.
  • Accurate diagnosis and stratification of CMD are improving.
  • Therapeutic options for CMD require further development and definition.
Keywords:
coronary blood flowcoronary flow reservecoronary microvascular diseasemicrovascular resistancenitric oxidephysiology-stratified disease endotypes

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