Di Carli Marcelo F
Cardiovascular Imaging Program, Division of Cardiovascular Medicine, Departments of Radiology and Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
Heart Fail Clin. 2025 Apr;21(2):201-214. doi: 10.1016/j.hfc.2025.01.002.
Coronary microvascular dysfunction (CMD) is a prevalent and often underdiagnosed condition with significant implications for adverse cardiovascular outcomes. The pathophysiology of CMD includes structural and functional abnormalities in the coronary microvasculature and epicardial atherosclerosis contributes to downstream reduction in myocardial perfusion and symptoms. Diagnosis relies on advanced invasive or noninvasive imaging techniques, such as PET and cardiac magnetic resonance, capable of quantifying myocardial perfusion and myocardial blood flow reserve. Effective management includes optimizing cardiovascular risk factors and symptom control. Novel therapeutic strategies recently approved for management of diabetes, obesity, and heart failure with preserved ejection fraction offer potentially powerful options for management of CMD.
冠状动脉微血管功能障碍（CMD）是一种普遍存在且常被漏诊的疾病，对不良心血管结局具有重大影响。CMD的病理生理学包括冠状动脉微血管的结构和功能异常，而心外膜动脉粥样硬化会导致下游心肌灌注减少和症状出现。诊断依赖于先进的有创或无创成像技术，如正电子发射断层扫描（PET）和心脏磁共振成像，这些技术能够量化心肌灌注和心肌血流储备。有效的管理包括优化心血管危险因素和控制症状。最近批准用于治疗糖尿病、肥胖症和射血分数保留的心力衰竭的新型治疗策略为CMD的管理提供了潜在的有力选择。
