Stratifying cardiovascular risk in patients with microvascular dysfunction: new insights from emerging physiology metrics

Coronary microvascular dysfunction (CMD) has been increasingly recognised as a common cause of myocardial ischaemia and typical angina symptoms. Recent reports have examined the mechanisms that are responsible for the mismatch of demand-supply of coronary blood flow in patients with CMD, providing unique insights about the pathophysiological processes that are responsible for this disease1,2. Today, two different endotypes of CMD have been identified, the structural endotype that is associated with increased nitric oxide synthase (NOS) activity resulting in augmented coronary flow at baseline, and the functional endotype where there is a weak augmentation of coronary blood flow at stress due ...