Classification, Diagnosis and Treatment of Coronary Microvascular Dysfunction

Dear Colleagues,

Coronary microvascular disfunction (CMVD) is an underdiagnosed condition defined by impaired structure and function of microvascular coronary vessels (MCV). CMVD is characterized by capillary rarefaction, inward remodeling of arterioles, impaired vasodilation, and paradoxical vasoconstriction of MCV. Cardiovascular risk factors, cardiomyopathies, inflammation, platelet activation, and autonomic dysfunction may act in coordination to determine CMVD, but not all of them need to be present. For example, patients with CMVD could present with myocardial infarction without coronary artery disease (MINOCA) or with myocardial ischemia without coronary artery disease (INOCA). These conditions are respectively characterized by patients presenting with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) in whom coronary angiography shows normal (< 30%) or near normal (30-50%) coronary arteries. Intravascular imaging with intravascular ultrasound (IVUS) and optical coherence tomography (OCT), and cardiac magnetic resonance (CMR) should be used for the differential diagnosis with other possible aetiologies of MINOCA and INOCA. Diagnosis of CMVD could be done via both non-invasive and invasive evaluation of coronary flow reserve (CFR) and through invasive provocative tests for the diagnosis of microvascular vasospasm. CMVD is associated with an increased risk of major adverse cardiac events. Lifestyle changes, risk factor management, anti-ischemic drugs, and aggressive therapy with statins and ace inhibitors are the cornerstone of therapy for CMVD.

Prof. Dr. Alfredo R. Galassi
Guest Editor

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