Coronary Microvascular Dysfunction in Cardiovascular Disease: Diagnosis and Management

Area of Science:

• Cardiology
• Vascular Biology
• Physiology

Background:

• Coronary microvascular dysfunction (CMD) is a key factor in myocardial ischemia and heart failure.
• The coronary microcirculation regulates heart perfusion via myogenic, metabolic, and endothelial pathways.
• Disrupted microcirculation leads to reduced vasodilatory capacity and microvascular ischemia.

Purpose of the Study:

• To review the anatomy, physiology, and pathophysiology of coronary microcirculation.
• To examine diagnostic strategies and clinical implications of CMD.
• To highlight therapeutic approaches and future research directions for CMD.

Main Methods:

• Literature review of coronary microcirculation and CMD.
• Analysis of pathophysiologic mechanisms including endothelial dysfunction and inflammation.
• Evaluation of diagnostic tools like invasive testing and advanced imaging (PET, CMR).

Main Results:

• CMD involves complex pathophysiologic mechanisms like endothelial dysfunction, structural remodeling, and inflammation.
• Diagnosis relies on invasive and noninvasive imaging techniques.
• CMD impacts diverse conditions such as ischemia with nonobstructive coronary arteries and cardiomyopathies.

Conclusions:

• CMD is a significant contributor to cardiovascular disease and adverse outcomes.
• Improved diagnostic accuracy and targeted therapies are needed.
• Further research is essential for advancing the management of CMD.