Coronary Microvascular Dysfunction Across the Spectrum of Cardiovascular Diseases: JACC State-of-the-Art Review
Marco Giuseppe Del Buono, Rocco A Montone, Massimiliano Camilli, Salvatore Carbone, Jagat Narula, Carl J Lavie, Giampaolo Niccoli, Filippo Crea, Marco Giuseppe Del Buono, Rocco A Montone, Massimiliano Camilli, Salvatore Carbone, Jagat Narula, Carl J Lavie, Giampaolo Niccoli, Filippo Crea
Abstract
Coronary microvascular dysfunction (CMD) encompasses several pathogenetic mechanisms involving coronary microcirculation and plays a major role in determining myocardial ischemia in patients with angina without obstructive coronary artery disease, as well as in several other conditions, including obstructive coronary artery disease, nonischemic cardiomyopathies, takotsubo syndrome, and heart failure, especially the phenotype associated with preserved ejection fraction. Unfortunately, despite the identified pathophysiological and prognostic role of CMD in several conditions, to date, there is no specific treatment for CMD. Due to the emerging role of CMD as common denominator in different clinical phenotypes, additional research in this area is warranted to provide personalized treatments in this "garden variety" of patients. The purpose of this review is to describe the pathophysiological mechanisms of CMD and its mechanistic and prognostic role across different cardiovascular diseases. We will also discuss diagnostic modalities and the potential therapeutic strategies resulting from recent clinical studies.
Keywords: HFpEF; INOCA; MINOCA; angina; coronary flow reserve; coronary microvascular dysfunction; coronary spasm; heart failure; ischemia; ischemic heart disease; microcirculation; microvascular angina; provocative testing.
Conflict of interest statement
Funding Support and Author Disclosures Dr Montone is supported by a Grant for Young Investigators “Ricerca Finalizzata GR-2019-12370197” from the Italian Ministry of Health. Dr Carbone is supported by a Career Development Award 19CDA34660318 from the American Heart Association and by the Clinical and Translational Science Awards Program UL1TR002649 from National Institutes of Health to Virginia Commonwealth University. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Source: PubMed