Coronary microvascular dysfunction in pregnancy: time to pay closer attention?

Q: What is the clinical evidence from this study?

Study design: Review. Population: Coronary microvascular dysfunction in pregnancy.

Eirini Beneki; Nikolaos Pyrpyris; Athanasios Sakalidis; Eirini Dri; P Iliakis; Theodoros Mprotsis; Francesco Perone; Aggelos Papanikolaou; Konstantinos Aznaouridis; Kyriakos Dimitriadis; Konstantinos Tsioufis; Constantina Aggeli

doi:10.3389/fcvm.2026.1734077

February 24, 2026SHILAP Revista de lepidopterologíaOpen Access

Coronary microvascular dysfunction in pregnancy: time to pay closer attention?

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Key result

Coronary microvascular dysfunction linked to adverse pregnancy outcomes and future CV risk.

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Why the study?

Coronary microvascular dysfunction is increasingly recognized as a significant cardiovascular condition, but its diagnosis and management during pregnancy remain poorly understood.

Key Points

To review current evidence on coronary microvascular dysfunction (CMD) during and after pregnancy, identify limitations of present diagnostic and therapeutic modalities, and highlight essential research gaps.
Synthesized existing cross-sectional and mechanistic evidence evaluating coronary microvascular function across preconception, pregnancy, and postpartum stages.
Assessed diagnostic modalities for CMD phenotyping, comparing non-invasive radiation-free techniques with advanced imaging and invasive coronary function testing.
CMD evaluation in symptomatic pregnant women is constrained by fetal safety concerns regarding radiation and pharmacologic stress agents, necessitating reliance on radiation-free tools such as transthoracic Doppler echocardiography or non-contrast cardiac magnetic resonance.
Postpartum phenotyping using contrast-enhanced CMR, PET, or invasive coronary testing is feasible and recommended for long-term cardiovascular risk stratification, particularly after hypertensive disorders of pregnancy.
Interventional trials, standardized diagnostic pathways, and longitudinal studies tracking microvascular recovery remain absent, leaving clinical management largely supportive and focused on conventional cardiovascular risk reduction.

PICO

P

Population

Coronary microvascular dysfunction in pregnancy

Coronary microvascular dysfunction during pregnancy is an under-recognized condition requiring standardized diagnostic strategies and dedicated clinical trials to improve maternal and long-term cardiovascular outcomes.

Limitations

Lack of prospective, longitudinal clinical trials assessing coronary microvascular function during pregnancy and postpartum.
Heterogeneity and limitations of diagnostic modalities for CMD especially in pregnant populations.
Insufficient control for confounding factors such as obesity, diabetes, and pre-existing cardiovascular risk.
Scarce mechanistic and interventional studies specific to CMD in pregnancy and postpartum women.
Limited clinical data linking CMD to hard cardiovascular outcomes in this population.
Existing studies are cross-sectional, limiting insight into the temporal evolution of CMD from pregnancy through the postpartum period
Diagnostic heterogeneity across studies introduces variability that hinders comparability and the establishment of standardized diagnostic criteria
Inadequate control for confounding factors such as obesity and diabetes that may influence microvascular function
Paucity of interventional trials in pregnant and postpartum women with CMD

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Implication

Warrants clinical vigilance for CMD in pregnancy; leaves open diagnostic and treatment strategies pending dedicated trials.

Abstract

Coronary microvascular dysfunction (CMD) is increasingly recognized as a significant cardiovascular condition, particularly among women, yet its diagnosis and management during pregnancy remain poorly understood. CMD may arise de novo in the context of hypertensive disorders of pregnancy or represent an exacerbation of pre-existing endothelial dysfunction. This article views current evidence surrounding CMD in pregnancy, outlines the limitations of current diagnostic and treatment approaches, and highlights critical research gaps that must be addressed to improve outcomes in this vulnerable population.

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Cite This Study

Beneki et al. (2026) conducted a review in Coronary microvascular dysfunction in pregnancy. Coronary microvascular dysfunction during pregnancy is linked to adverse pregnancy outcomes and future cardiovascular risk, but no prospective trials have evaluated diagnostic or treatment strategies specific to this population.

synapsesocial.com/papers/69a1344fed1d949a99abe1f5 https://doi.org/10.3389/fcvm.2026.1734077

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Coronary microvascular dysfunction in pregnancy: time to pay closer attention?

Figures

Key Points

PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Coronary microvascular dysfunction in pregnancy: time to pay closer attention?

Figures

Key Points

PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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