Author + information
- Received July 23, 2018
- Revision received September 6, 2018
- Accepted September 25, 2018
- Published online November 19, 2018.
- Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Marcelo F. Di Carli, 75 Francis Street, ASB-L1 037C, Boston, Massachusetts 02115.
Coronary microvascular disease (CMD) refers to the subset of disorders affecting the structure and function of the coronary microcirculation, is prevalent in patients across a broad spectrum of cardiovascular risk factors, and is associated with an increased risk of adverse events. Contemporary evidence supports that most patients with CMD also have macrovessel atherosclerosis, which has important implications for their prognosis and management. In this state-of-the-art review, the authors summarize the pathophysiology of CMD, provide an update of diagnostic testing strategies, and classify CMD into phenotypes according to severity and coexistence with atherosclerosis. They examine emerging data highlighting the significance of CMD in specific populations, including obesity and insulin resistance, myocardial injury and heart failure with preserved ejection fraction, and nonobstructive and obstructive coronary artery disease. Finally, they discuss the role of CMD as a potential target for novel interventions beyond conventional approaches, representing a new frontier in cardiovascular disease reduction.
- coronary flow reserve
- coronary microvascular dysfunction
- heart failure with preserved ejection fraction
- ischemic heart disease
- nonobstructive coronary artery disease
This work was supported by K23HL135438 to Dr. Taqueti and R01HL132021 to Dr. Di Carli. Dr. Di Carli has received consulting fees from Sanofi and General Electric; and has received a research grant from Spectrum Dynamics.
- Received July 23, 2018.
- Revision received September 6, 2018.
- Accepted September 25, 2018.
- 2018 American College of Cardiology Foundation
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