O'Hara Meaghan, Roy Rukmini, Altenburg Marie, Slivnick Jeremy, Patel Hena
Department of Medicine, Unviersity of Chicago, Chicago, IL, USA.
Curr Atheroscler Rep. 2025 Jun 12;27(1):65. doi: 10.1007/s11883-025-01310-1.
Microvascular dysfunction (MD) is a systemic condition implicated in a wide range of pathologies, including ischemic heart disease (IHD), stroke, chronic kidney disease (CKD), dementia, pulmonary arterial hypertension (PAH), and pregnancy complications. MD encompasses conditions characterized by small-vessel obstruction, impaired oxygen delivery, defective clearance of cellular waste, and inadequate gas exchange, ultimately leading to tissue damage and organ dysfunction. This review identifies the role of MD in the pathogenesis of a variety of diseases and across organ systems. It highlights the disproportionate burden of MD in women, with a focus on sex-specific risk factors, especially pregnancy.
In recent years, there has been increased recognition of the role of MD in the pathogenesis of both cardiac and non-cardiac diseases. Advances in imaging modalities, such as coronary flow reserve assessment and endothelial function testing, have improved the detection of microvascular dysfunction across organ systems. Studies have also highlighted the connection between MD and systemic inflammation, oxidative stress, and hormonal influences, particularly in women. Emerging research suggests that pregnancy-related complications, including preeclampsia and gestational hypertension, may serve as early markers of long-term microvascular dysfunction and cardiovascular disease risk.
This review focuses on coronary microvascular dysfunction (CMD) in women, with additional discussion of endothelial and microvascular dysfunction in the renovascular, cerebrovascular, and pulmonary arterial systems. This review describes diagnostic and therapeutic approaches for MD in diverse disease contexts and emphasizes the critical need for research to advance diagnostic tools and therapeutic strategies tailored to the unique needs of women.
微血管功能障碍（MD）是一种全身性疾病，与多种病理状况相关，包括缺血性心脏病（IHD）、中风、慢性肾脏病（CKD）、痴呆、肺动脉高压（PAH）和妊娠并发症。MD包括以小血管阻塞、氧输送受损、细胞废物清除缺陷和气体交换不足为特征的病症，最终导致组织损伤和器官功能障碍。本综述确定了MD在多种疾病发病机制以及跨器官系统中的作用。它强调了MD在女性中不成比例的负担，重点关注性别特异性风险因素，尤其是妊娠。
近年来，人们越来越认识到MD在心脏和非心脏疾病发病机制中的作用。成像方式的进展，如冠状动脉血流储备评估和内皮功能测试，改善了对跨器官系统微血管功能障碍的检测。研究还强调了MD与全身炎症、氧化应激和激素影响之间的联系，特别是在女性中。新兴研究表明，包括先兆子痫和妊娠期高血压在内的妊娠相关并发症可能是长期微血管功能障碍和心血管疾病风险的早期标志物。
本综述重点关注女性冠状动脉微血管功能障碍（CMD），并额外讨论肾血管、脑血管和肺动脉系统中的内皮和微血管功能障碍。本综述描述了不同疾病背景下MD的诊断和治疗方法，并强调迫切需要开展研究，以推进针对女性独特需求的诊断工具和治疗策略。
