Dysfunction of the coronary microvasculature has become increasingly recognized as an important mechanism of myocardial ischemia in patients without obstructive coronary artery disease. The causes and management of coronary microvascular dysfunction remain poorly understood and are still largely based on extrapolation of epicardial coronary artery disease data. Quantification of myocardial blood flow and flow reserve have improved diagnosis, though important questions remain. In this review, we explain current understanding of the spectrum of pathophysiology of coronary microvascular dysfunction, summarize current diagnostic techniques to assess for coronary microvascular dysfunction, and appraise the limited data on management options specifically for patients with coronary microvascular dysfunction.
Keyphrases
- coronary artery disease
- coronary artery
- percutaneous coronary intervention
- oxidative stress
- cardiovascular events
- blood flow
- coronary artery bypass grafting
- end stage renal disease
- newly diagnosed
- left ventricular
- chronic kidney disease
- heart failure
- palliative care
- cardiovascular disease
- ejection fraction
- type diabetes
- acute coronary syndrome
- big data
- transcatheter aortic valve replacement