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Coronary microvascular dysfunction in angina and non-obstructive coronary arteries: Pathophysiology, diagnosis, novel

Domenico Galante1, Giulia La Vecchia2,3, Antonio Maria Leone2,3

  • 1Center of Excellence of Cardiovascular Sciences, Ospedale Isola Tiberina - Gemelli Isola, Rome, Italy. Filippo.Crea@unicatt.it.

Kardiologia Polska
|March 13, 2025
PubMed

Insights

Coronary microvascular dysfunction causes myocardial ischemia in patients with angina. This review covers its diagnosis, pathophysiology, and emerging treatments for this heart condition.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Internal Medicine

Background:

  • Coronary microvascular dysfunction (CMD) involves abnormalities in small heart vessels, leading to myocardial ischemia.
  • It affects patients with angina and non-obstructive coronary artery disease, impacting cardiovascular health.
  • Current diagnostic methods include assessing vasodilator capacity and microvascular spasm via invasive coronary angiography.

Purpose of the Study:

  • To provide a comprehensive overview of coronary microvascular dysfunction.
  • To discuss the pathophysiology, diagnostic approaches, and therapeutic strategies for CMD.
  • To highlight emerging biomarkers, novel therapeutic targets, and unmet needs in CMD management.

Main Methods:

  • Review of existing literature on coronary microvascular dysfunction.
  • Analysis of diagnostic criteria and invasive assessment techniques.
  • Exploration of current and potential future therapeutic interventions.

Main Results:

  • CMD is a significant factor in myocardial ischemia, particularly in angina patients without obstructive coronary artery disease.
  • Invasive coronary angiography is key for diagnosis, evaluating vasodilator function and spasm.
  • Despite clinical importance, specific treatments for CMD remain limited.

Conclusions:

  • CMD requires targeted therapeutic strategies due to its clinical and prognostic significance.
  • Further research into novel biomarkers and therapeutic targets is crucial for effective CMD management.
  • Addressing knowledge gaps is essential to improve patient outcomes for coronary microvascular dysfunction.

Keywords:
anginacoronary microvascular dysfunctionno-obstructive coronary arteries

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