Salient Journal of Cardiology (ISSN 2994-774X) | Volume 1, Issue 1 | Review Article | Open Access

Coronary Microvascular Dysfunction: A Comprehensive Review

Kishor Khanal*

Memorial HealthCare System, Hollywood, Florida, USA

*Correspondence to: Kishor Khanal 

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Coronary Microvascular Dysfunction (CMD) encompasses a range of structural and functional changes at the level of coronary microcirculation, eventually resulting in diminished Coronary Blood Flow (CBF) and, thereby, myocardial ischemia. It has been shown to be linked to high morbidity and mortality. While patients can have traditional cardiovascular risk factors, CMD may or may not be associated with coronary artery disease or other myocardial diseases. When present, the obstructive lesions can complicate the evaluation and management of CMD. Although various non-invasive techniques, including cardiac Positron Emission Tomography (PET) or Magnetic Resonance Imaging (MRI), can be incorporated into the evaluation of CMD, a complete evaluation is possible only with invasive methods. Different pharmaceutical agents can be utilized to assess endothelial-dependent and non-endothelial-dependent processes, as well as macrovascular (epicardial) and microvascular involvement, in order to distinguish abnormalities in the coronary circulation. The lack of standardized diagnostic criteria and limited effective therapeutic options contribute to the complexity of successfully treating CMD. Antianginals, statins, and other therapies that aggressively modify the risk factors have been the mainstay of treatment, with a goal to improve quality of life and event-free survival. Despite recent advances, there is still a considerable gap in the understanding of its pathophysiology, accurate diagnosis, and definitive treatment. This warrants further dedicated research and trials.


Coronary microvascular dysfunction; Coronary blood flow; Cardiac magnetic resonance imaging; Coronary flow reserve; Coronary flow velocity ratio; Electrocardiogram; Index of microvascular resistance; Myocardial blood flow; Myocardial perfusion reserve; Positron emission tomography


Kishor Khanal. Coronary Microvascular Dysfunction: A Comprehensive Review. Sali Jour Cardi. 2022;1(1):1-13.