Quarta Rossella, Martino Giovanni, Romano Letizia Rosa, Lopes Giovanni, Greco Francesco Fabio, Spaccarotella Carmen Anna Maria, Indolfi Ciro, Curcio Antonio, Polimeni Alberto
Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy.
Division of Cardiology, Annunziata Hospital, 87100 Cosenza, Italy.
Biomolecules. 2025 Jan 25;15(2):177. doi: 10.3390/biom15020177.
Coronary microvascular disease (CMD) comprises a spectrum of conditions characterized by the functional and structural abnormalities of coronary microcirculation, affecting vessels typically smaller than 500 μm. Despite its clinical significance as a contributor to myocardial ischemia, CMD frequently remains underdiagnosed due to the limitations of current diagnostic approaches. Invasive testing, including coronary reactivity assessment, is considered the gold standard, but it is resource-intensive and not always accessible. Non-invasive methods, such as positron emission tomography (PET) and transthoracic Doppler echocardiography (TTDE), offer alternatives but are limited by varying accuracy and accessibility. Amid these diagnostic challenges, there is increasing interest in circulating biomarkers as adjuncts in CMD evaluation. Biomarkers associated with endothelial dysfunction, inflammation, and oxidative stress, detectable through routine blood tests, may assist in CMD diagnosis, risk stratification, and therapeutic monitoring. These biomarkers can offer insights into CMD pathogenesis and enable early, non-invasive screening to identify patients who may benefit from more invasive investigations. This narrative review examines studies assessing biomarkers in CMD patients with diagnoses confirmed through invasive techniques. Our objective is to focus on circulating biomarkers linked to the invasive evaluation of coronary microcirculation, aiming to advance the understanding of the underlying mechanisms of this prevalent condition and enhance diagnostic accuracy and the clinical management of affected patients.
冠状动脉微血管疾病（CMD）包括一系列以冠状动脉微循环功能和结构异常为特征的病症，影响通常直径小于500μm的血管。尽管CMD作为心肌缺血的一个成因具有临床意义，但由于当前诊断方法的局限性，CMD常常仍未得到充分诊断。包括冠状动脉反应性评估在内的侵入性检测被认为是金标准，但它资源密集且并非总是可行。非侵入性方法，如正电子发射断层扫描（PET）和经胸多普勒超声心动图（TTDE），提供了替代方案，但受到准确性和可行性各异的限制。在这些诊断挑战中，人们对循环生物标志物作为CMD评估的辅助手段的兴趣日益增加。通过常规血液检测可检测到的与内皮功能障碍、炎症和氧化应激相关的生物标志物，可能有助于CMD的诊断、风险分层和治疗监测。这些生物标志物可以深入了解CMD的发病机制，并实现早期非侵入性筛查，以识别可能从更具侵入性的检查中获益的患者。本叙述性综述考察了评估通过侵入性技术确诊的CMD患者生物标志物的研究。我们的目标是聚焦于与冠状动脉微循环侵入性评估相关的循环生物标志物，旨在增进对这种常见病症潜在机制的理解，并提高诊断准确性以及改善受影响患者的临床管理。
