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Updated: Sep 18, 2025

Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
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Coronary microvascular dysfunction: Focus on pathophysiological mechanisms and recent diagnostic techniques

Gianluca Mincione1, Matteo Maurina2, Alice Benedetti3

  • 1Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|June 25, 2025
PubMed

Insights

Coronary microvascular dysfunction affects patients without visible blockages. This review explores its causes, new diagnostic tools, and personalized treatments based on patient endotypes.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Diagnostic Imaging

Background:

  • Traditional interventional cardiology focuses on epicardial coronary artery lesions.
  • A subset of patients presents with symptoms similar to epicardial disease but lacks angiographic evidence.
  • These cases are increasingly recognized as manifestations of coronary microvascular dysfunction.

Purpose of the Study:

  • To review the pathophysiology of coronary microvascular dysfunction.
  • To highlight novel diagnostic approaches for this condition.
  • To discuss emerging therapeutic strategies tailored to specific endotypes.

Main Methods:

  • Literature review of pathophysiology, diagnostics, and therapeutics.
  • Focus on endotype-specific treatment strategies.
  • Exploration of new diagnostic modalities beyond traditional angiography.

Main Results:

  • Coronary microvascular dysfunction represents a distinct clinical entity.
  • Advancements in diagnostic techniques are improving detection rates.
  • Personalized therapeutic strategies based on endotype are showing promise.

Conclusions:

  • Coronary microvascular dysfunction is a significant cause of ischemic symptoms.
  • Early and accurate diagnosis is crucial for effective management.
  • Tailoring treatment to endotypes offers a path towards improved patient outcomes.

Keywords:
CoronaryDysfunctionMicrovascular

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