Impaired Coronary Microcirculation and Myocardial Systolic Function: A Narrative Review on Non-Invasive Assessment in Cardiovascular Diseases

Area of Science:

• Cardiology
• Medical Imaging
• Physiology

Background:

• Coronary microvascular dysfunction (CMD) is a condition of reduced coronary blood flow linked to adverse cardiac events.
• Evidence suggests coronary microcirculation impairment occurs in various cardiovascular pathologies.
• Non-invasive assessment of CMD is challenging, impacting clinical management.

Purpose of the Study:

• To review current evidence on non-invasive imaging modalities for assessing CMD.
• To examine the association between CMD indices and systolic myocardial function.
• To highlight CMD as a potential therapeutic target in cardiovascular diseases.

Main Methods:

• Review of current literature on CMD imaging techniques.
• Analysis of studies correlating CMD indices with systolic function markers (e.g., LVEF, GLS, myocardial work).
• Discussion of limitations and diagnostic utility of various imaging modalities (PET, CT, CMR, MCE, TTE).

Main Results:

• Several non-invasive imaging modalities (PET, CT, CMR, MCE, TTE) can quantify coronary flow reserve (CFR) and myocardial blood flow (MBF).
• Each imaging modality has limitations regarding availability, standardization, and diagnostic utility.
• Growing evidence links CMD indices with systolic function markers in cardiovascular diseases.

Conclusions:

• Understanding the impact of CMD on myocardial function is vital.
• Coronary microcirculation impairment is a key pathway in cardiovascular disease.
• CMD assessment and its relationship with systolic function may guide future therapeutic strategies.