Sokratous Stefanos, Mitsis Andreas, Khattab Elina, Karelas Dimitrios, Velidakis Nikolaos, Kadoglou Nikolaos P E
Medical School, University of Cyprus, 2029 Nicosia, Cyprus.
Department of Cardiology, General Hospital of Nicosia, 2031 Strovolos, Cyprus.
Biomedicines. 2025 May 23;13(6):1289. doi: 10.3390/biomedicines13061289.
Coronary microvascular disease (CMVD) is not an uncommon complication after acute myocardial infarction (AMI), independent of prompt revascularization. It is a serious yet underdiagnosed disease that has a major impact on patient outcomes. Even when the infarct-related artery is successfully revascularized, a significant percentage of patients still have compromised microvascular circulation, which is linked to higher cardiovascular mortality and hospitalization for heart failure. The well-known invasive methods, such as the index of microvascular resistance (IMR) and the coronary flow reserve (CFR), have been considered as gold standards. However, they are constrained by their hazards and complexity. Non-invasive techniques, such as echocardiography Doppler for CFR assessment, positron emission tomography (PET), cardiac magnetic resonance imaging (CMR), and some other techniques provide alternatives, but their accessibility, cost and implementation during the peri-AMI period raise obstacles to their wider use. This review highlights both invasive and non-invasive modalities as it examines the diagnostic methods and prognostic significance of CMVD development early after AMI. Enhancing long-term results in this high-risk population requires a thorough understanding of pathophysiology and a commitment to larger diagnostic and prognostic studies for CMVD.
冠状动脉微血管疾病（CMVD）是急性心肌梗死（AMI）后一种并不罕见的并发症，与及时的血运重建无关。它是一种严重但诊断不足的疾病，对患者的预后有重大影响。即使梗死相关动脉成功实现血运重建，仍有相当比例的患者微血管循环受损，这与更高的心血管死亡率和因心力衰竭住院有关。诸如微血管阻力指数（IMR）和冠状动脉血流储备（CFR）等知名的有创方法一直被视为金标准。然而，它们受到其风险和复杂性的限制。无创技术，如用于评估CFR的超声心动图多普勒、正电子发射断层扫描（PET）、心脏磁共振成像（CMR）以及其他一些技术提供了替代方法，但它们在AMI围术期的可及性、成本和实施过程对其更广泛应用构成了障碍。本综述在探讨AMI后早期CMVD发生的诊断方法和预后意义时，突出了有创和无创两种方式。要改善这一高危人群的长期预后，需要深入了解病理生理学，并致力于开展针对CMVD的更大规模的诊断和预后研究。
