Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy. Electronic address: https://twitter.com/marcodelbuono3.
Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
J Am Coll Cardiol. 2021 Sep 28;78(13):1352-1371. doi: 10.1016/j.jacc.2021.07.042.
Coronary microvascular dysfunction (CMD) encompasses several pathogenetic mechanisms involving coronary microcirculation and plays a major role in determining myocardial ischemia in patients with angina without obstructive coronary artery disease, as well as in several other conditions, including obstructive coronary artery disease, nonischemic cardiomyopathies, takotsubo syndrome, and heart failure, especially the phenotype associated with preserved ejection fraction. Unfortunately, despite the identified pathophysiological and prognostic role of CMD in several conditions, to date, there is no specific treatment for CMD. Due to the emerging role of CMD as common denominator in different clinical phenotypes, additional research in this area is warranted to provide personalized treatments in this "garden variety" of patients. The purpose of this review is to describe the pathophysiological mechanisms of CMD and its mechanistic and prognostic role across different cardiovascular diseases. We will also discuss diagnostic modalities and the potential therapeutic strategies resulting from recent clinical studies.
冠状动脉微血管功能障碍（CMD）包含涉及冠状动脉微循环的几个发病机制，在确定心绞痛而无阻塞性冠状动脉疾病患者的心肌缺血方面起着主要作用，并且在其他几种情况下也起着主要作用，包括阻塞性冠状动脉疾病、非缺血性心肌病、心尖球形综合征和心力衰竭，特别是与射血分数保留相关的表型。不幸的是，尽管 CMD 在几种情况下的病理生理和预后作用已得到确定，但迄今为止，CMD 尚无特异性治疗方法。由于 CMD 作为不同临床表型的共同决定因素的作用不断显现，因此需要在这一领域开展更多的研究，以便为这些“普通”患者提供个体化治疗。本文的目的是描述 CMD 的病理生理机制及其在不同心血管疾病中的机制和预后作用。我们还将讨论诊断方式以及最近临床研究带来的潜在治疗策略。
