Scarica Vincenzo, Rinaldi Riccardo, Animati Francesco Maria, Manzato Matteo, Montone Rocco A
Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy.
Cardiology Unit, Infermi Hospital, Rimini, Italy.
EXCLI J. 2025 Mar 26;24:454-478. doi: 10.17179/excli2025-8285. eCollection 2025.
Ischemic heart disease (IHD) is a leading cause of morbidity and mortality worldwide, presenting with acute and chronic coronary syndromes. Although coronary atherosclerosis is a major cause of IHD, many patients with angina or myocardial ischemia do not have obstructive coronary heart disease and impairment of the coronary microcirculation has been increasingly implicated as a relevant cause of IHD. Therefore, coronary microvascular dysfunction (CMD) refers to a term covering a wide spectrum of structural and functional alterations which affect the coronary microcirculation leading to myocardial ischemia and angina. The advent of non-invasive and invasive functional tests has exponentially broadened the ability to recognize CMD and delineate related clinical and biochemical features. Despite major advances in diagnosing and stratifying this condition, therapeutic strategies remain limited and poorly defined. In this review, we will provide an overview of the pathophysiology and the diagnostic evaluation of CMD across the spectrum of cardiovascular diseases. Furthermore, we will discuss the novel therapeutic strategies available for these patients in the perspective of a personalized medicine approach.
缺血性心脏病（IHD）是全球发病和死亡的主要原因，表现为急性和慢性冠状动脉综合征。虽然冠状动脉粥样硬化是IHD的主要原因，但许多心绞痛或心肌缺血患者并无阻塞性冠状动脉疾病，而冠状动脉微循环障碍越来越被认为是IHD的相关病因。因此，冠状动脉微血管功能障碍（CMD）是一个涵盖广泛结构和功能改变的术语，这些改变会影响冠状动脉微循环，导致心肌缺血和心绞痛。非侵入性和侵入性功能测试的出现极大地拓宽了识别CMD以及描绘相关临床和生化特征的能力。尽管在诊断和分层这种疾病方面取得了重大进展，但治疗策略仍然有限且定义不明确。在本综述中，我们将概述CMD在心血管疾病范围内的病理生理学和诊断评估。此外，我们将从个性化医疗方法的角度讨论这些患者可用的新型治疗策略。
