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Coronary microvascular dysfunction: pathophysiology, diagnosis, and therapeutic strategies across cardiovascular

Vincenzo Scarica1, Riccardo Rinaldi1,2, Francesco Maria Animati1

  • 1Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy.

EXCLI Journal
|May 16, 2025
PubMed

Insights

Coronary microvascular dysfunction (CMD) contributes to ischemic heart disease (IHD) even without obstructive coronary artery disease. This review covers CMD pathophysiology, diagnosis, and emerging personalized treatment strategies for better patient outcomes.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Internal Medicine

Background:

  • Ischemic heart disease (IHD) is a major global health burden, often linked to coronary atherosclerosis.
  • A significant subset of patients with angina or myocardial ischemia lack obstructive coronary artery disease, suggesting other underlying causes.
  • Coronary microvascular dysfunction (CMD) is increasingly recognized as a key contributor to IHD, involving structural and functional microcirculatory alterations.

Purpose of the Study:

  • To provide a comprehensive overview of the pathophysiology of coronary microvascular dysfunction (CMD).
  • To detail the diagnostic evaluation of CMD across various cardiovascular diseases.
  • To explore novel therapeutic strategies for CMD, emphasizing a personalized medicine approach.

Main Methods:

  • Review of existing literature on coronary microvascular dysfunction.
  • Analysis of diagnostic advancements, including non-invasive and invasive functional tests.
  • Synthesis of current understanding of CMD pathophysiology and clinical features.

Main Results:

  • CMD is a significant cause of myocardial ischemia and angina, particularly in patients without obstructive coronary artery disease.
  • Diagnostic capabilities for CMD have advanced significantly, enabling better recognition and characterization.
  • Despite diagnostic progress, effective therapeutic options for CMD remain limited and require further definition.

Conclusions:

  • CMD represents a critical, yet often overlooked, component of ischemic heart disease.
  • Accurate diagnosis and stratification of CMD are crucial for guiding treatment decisions.
  • Future research should focus on developing and validating personalized therapeutic strategies for CMD to improve patient management and outcomes.

Keywords:
ANOCAINOCAcoronary microvascular dysfunctioncoronary spasmprecision medicine

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