Coronary Microvascular Dysfunction in Cardiomyopathies: Insights on Clinical and Prognostic Roles

Area of Science:

• Cardiology
• Cardiovascular Research
• Translational Medicine

Background:

• Coronary microvascular dysfunction (CMD) is increasingly recognized as a critical factor in the pathophysiology and prognosis of various non-ischemic cardiomyopathies.
• Understanding the role of CMD across different cardiomyopathies is essential for improving patient management and outcomes.

Purpose of the Study:

• To review diagnostic tools for microvascular dysfunction.
• To summarize evidence on CMD incidence and its prognostic significance in patients with cardiomyopathies.
• To explore current and potential therapeutic strategies for CMD.

Main Methods:

• Literature review of diagnostic modalities for CMD.
• Synthesis of evidence on CMD prevalence and prognostic impact in dilated, hypertrophic, Takotsubo, arrhythmogenic right ventricular, and infiltrative cardiomyopathies.
• Analysis of therapeutic interventions targeting CMD.

Main Results:

• CMD is prevalent and associated with adverse outcomes in dilated and hypertrophic cardiomyopathies.
• In Takotsubo syndrome, CMD is acute and reversible, often involving spasms.
• Preliminary data suggest CMD involvement in arrhythmogenic right ventricular cardiomyopathy, while it's an early feature in infiltrative diseases like amyloidosis and Anderson-Fabry disease, and linked to inflammation in sarcoidosis.

Conclusions:

• Integrating microcirculatory assessment into clinical practice can enhance risk stratification for patients with cardiomyopathies.
• CMD represents a significant therapeutic target, although current targeted therapies are limited.
• Further research into device-based and nonpharmacologic strategies is warranted to address CMD effectively across cardiomyopathies.