This review discusses the pathophysiology, clinical context, and non-invasive diagnostic methods for identifying coronary microvascular dysfunction in stable ischaemic heart disease.
Coronary microvascular dysfunction is an important contributor to stable ischemic heart disease that may explain persistent symptoms and requires specific non-invasive diagnostic approaches.
Diffuse and focal epicardial coronary disease and coronary microvascular abnormalities may exist side-by-side. Identifying the contributions of each of these three players in the coronary circulation is a difficult task. Yet identifying coronary microvascular dysfunction (CMD) as an additional player in patients with coronary artery disease (CAD) may provide explanations of why symptoms may persist frequently following and why global coronary flow reserve may be more prognostically important than fractional flow reserve measured in a single vessel before percutaneous coronary intervention. This review focuses on the challenges of identifying the presence of CMD in the context of diffuse non-obstructive CAD and obstructive CAD. Furthermore, it is going to discuss the pathophysiology in this complex situation, examine the clinical context in which the interaction of the three components of disease takes place and finally look at non-invasive diagnostic methods relevant for addressing this question.
Sechtem et al. (Wed,) conducted a review in Stable ischaemic heart disease. Coronary microvascular dysfunction was evaluated. This review discusses the pathophysiology, clinical context, and non-invasive diagnostic methods for identifying coronary microvascular dysfunction in stable ischaemic heart disease.