Pathophysiology of Coronary Microvascular Dysfunction

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  • Crea Filippo
    Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart
  • Montone Rocco A.
    Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS
  • Rinaldi Riccardo
    Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart

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<p>Ischemic heart disease (IHD) is commonly recognized as the consequence of coronary atherosclerosis and obstructive coronary artery disease (CAD). However, a significant number of patients may present angina or myocardial infarction even in the absence of any significant coronary artery stenosis and impairment of the coronary microcirculation has been increasingly implicated as a relevant cause of IHD. The term “coronary microvascular dysfunction” (CMD) encompasses several pathogenic mechanisms resulting in functional and/or structural changes in the coronary microcirculation and determining angina and myocardial ischemia in patients with angina without obstructive CAD (“primary” microvascular angina), as well as in several other conditions, including obstructive CAD, cardiomyopathies, Takotsubo syndrome and heart failure, especially the phenotype with preserved ejection fraction. The pathogenesis of CMD is complex and involves the combination of functional and structural alterations leading to impaired coronary blood flow and resulting in myocardial ischemia. In the absence of therapies specifically targeting CMD, attention has been focused on the role of modifiable risk factors. Here, we provide updated evidence regarding the pathophysiological mechanisms underlying CMD, with a particular focus on the role of cardiovascular risk factors and comorbidities. Moreover, we discuss the specific pathogenic mechanisms of CMD across the different cardiovascular diseases, aiming to pave the way for further research and the development of novel strategies for a precision medicine approach.</p>

収録刊行物

  • Circulation Journal

    Circulation Journal 86 (9), 1319-1328, 2022-08-25

    一般社団法人 日本循環器学会

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