Coronary Microvascular Dysfunction: A Guide for Clinicians

Area of Science:

• Cardiology
• Vascular Biology
• Myocardial Pathophysiology

Background:

• Coronary microvascular dysfunction (CMD) is increasingly recognized as a cause of myocardial ischemia, particularly in patients without obstructive coronary artery disease (CAD).
• Understanding of CMD pathophysiology and management is limited, often relying on data extrapolated from epicardial CAD.
• Accurate diagnosis and targeted therapies for CMD are crucial but remain challenging.

Purpose of the Study:

• To review the current understanding of the pathophysiology of coronary microvascular dysfunction.
• To summarize diagnostic techniques for assessing CMD.
• To evaluate existing management strategies for CMD.

Main Methods:

• Literature review focusing on pathophysiology, diagnosis, and management of CMD.
• Analysis of studies involving myocardial blood flow and flow reserve quantification.
• Appraisal of clinical data specific to CMD patients.

Main Results:

• CMD is a significant contributor to myocardial ischemia in non-obstructive CAD.
• Diagnostic tools like myocardial blood flow quantification have improved, but gaps remain.
• Evidence-based management options for CMD are scarce.

Conclusions:

• Further research is needed to elucidate CMD pathophysiology and develop targeted treatments.
• Improved diagnostic accuracy is essential for timely intervention in CMD.
• Specific management guidelines for CMD are required to optimize patient outcomes.