Key result
Emerging CMD treatments target endothelial homeostasis through vasodilation, anti-inflammation, and antioxidant effects.
Why the study?
Coronary microvascular dysfunction plays a pivotal role in cardiovascular diseases, prompting a summary of recent advances in its pathophysiology, assessment, treatment strategies, and ongoing challenges.
This review provides a comprehensive overview of the pathophysiological mechanisms, signaling pathways, and clinical implications of coronary microvascular dysfunction across various cardiovascular diseases.
CMD advances remain hypothesis-generating; leaves open whether pathway-targeted or precision therapies will improve outcomes.
Coronary microvascular dysfunction (CMD) refers to structural and functional abnormalities of the microcirculation that impair myocardial perfusion. CMD plays a pivotal role in numerous cardiovascular diseases, including myocardial ischemia with non-obstructive coronary arteries, heart failure, and acute coronary syndromes. This review summarizes recent advances in CMD pathophysiology, assessment, and treatment strategies, as well as ongoing challenges and future research directions. Signaling pathways implicated in CMD pathogenesis include adenosine monophosphate-activated protein kinase/Krüppel-like factor 2/endothelial nitric oxide synthase (AMPK/KLF2/eNOS), nuclear factor erythroid 2-related factor 2/antioxidant response element (Nrf2/ARE), Angiotensin II (Ang II), endothelin-1 (ET-1), RhoA/Rho kinase, and insulin signaling. Dysregulation of these pathways leads to endothelial dysfunction, the hallmark of CMD. Treatment strategies aim to reduce myocardial oxygen demand, improve microcirculatory function, and restore endothelial homeostasis through mechanisms including vasodilation, anti-inflammation, and antioxidant effects. Traditional Chinese medicine (TCM) compounds exhibit therapeutic potential through multi-targeted actions. Small molecules and regenerative approaches offer precision therapies. However, challenges remain in translating findings to clinical practice and developing effective pharmacotherapies. Integration of engineering with medicine through microfabrication, tissue engineering and AI presents opportunities to advance the diagnosis, prediction, and treatment of CMD.
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Wang et al. (2024) conducted a review in Coronary microvascular dysfunction. Coronary microvascular dysfunction plays a pivotal role in numerous cardiovascular diseases, with emerging treatment strategies aiming to restore endothelial homeostasis through vasodilation, anti-inflammation, and antioxidant effects.
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