Expanding landscape of coronary microvascular disease in co-morbid conditions: Metabolic disease and beyond

Area of Science:

• Cardiovascular Science
• Pathophysiology
• Translational Medicine

Background:

• Coronary microvascular disease (CMD) and impaired coronary blood flow control are early defects in heart failure pathogenesis within cardiometabolic conditions.
• CMD precedes atherosclerosis and is an independent predictor of cardiac morbidity and mortality in patients with obesity and metabolic disease.
• CMD involves functional, structural, and mechanical impairments reducing coronary blood flow in metabolic disease and other conditions like transplant, autoimmune disorders, cardiotoxicity, and remote injury.

Purpose of the Study:

• To review the current understanding of CMD in metabolic and comorbid conditions.
• To synthesize mechanistic data from preclinical animal models with available clinical evidence.
• To identify knowledge gaps and future research opportunities in CMD.

Main Methods:

• Review of contemporary literature on Coronary Microvascular Disease (CMD).
• Focus on mechanistic data from preclinical small- and large-animal models.
• Integration of available clinical evidence, acknowledging limitations in human studies.

Main Results:

• CMD is a significant early defect in heart failure associated with cardiometabolic conditions.
• CMD predicts cardiac events and is linked to obesity and metabolic disease.
• Mechanisms of CMD are explored across metabolic, transplant, autoimmune, cardiotoxicity, and remote injury contexts.

Conclusions:

• CMD is a critical factor in heart failure development across various conditions.
• Preclinical models provide valuable mechanistic insights into CMD.
• Further research is needed to bridge the gap between animal models and human clinical applications for CMD.