Coronary microvascular dysfunction (CMD) involves functional or structural abnormalities of the coronary microvasculature resulting in dysregulation of coronary blood flow (CBF) in response to myocardial oxygen demand. This perfusion mismatch causes myocardial ischemia, which manifests in patients as microvascular angina (MVA). CMD can be diagnosed non-invasively via multiple imaging techniques or invasively using coronary function testing (CFT), which assists in determining the specific mechanisms involving endothelium-independent and dependent epicardial and microcirculation domains. Unlike traditional coronary artery disease (CAD), CMD can often occur in patients without obstructive atherosclerotic epicardial disease, which can make the diagnosis of CMD difficult. Moreover, MVA due to CMD is more prevalent in women and carries increased risk of future cardiovascular events. Successful treatment of symptomatic CMD is often patient-specific risk factor and endotype targeted. This article aims to review newly identified mechanisms and novel treatment strategies for managing CMD, and outline sex-specific differences in the presentation and pathophysiology of the disease.
Keyphrases
- coronary artery disease
- cardiovascular events
- coronary artery
- percutaneous coronary intervention
- end stage renal disease
- coronary artery bypass grafting
- blood flow
- ejection fraction
- chronic kidney disease
- risk factors
- newly diagnosed
- prognostic factors
- left ventricular
- polycystic ovary syndrome
- aortic stenosis
- magnetic resonance imaging
- oxidative stress
- peritoneal dialysis
- cardiovascular disease
- computed tomography
- magnetic resonance
- high resolution
- patient reported outcomes
- insulin resistance
- acute coronary syndrome
- cancer therapy
- mass spectrometry
- aortic valve
- current status
- contrast enhanced
- fluorescence imaging