Coronary Microvascular Dysfunction: Pathophysiology, Diagnosis, and Emerging Clinical Strategies

Abstract

Coronary Microvascular Disease (CMD) as well as Small Vessel Disease (SVD) are recognized for myocardial ischemia, mostly In patient with angina. In recent time diagnosis of obstructive CAD via cardiac catheterization and visualizing the epicardial vessel became a gold standard method and the prognosis changed into importantly constrained to large vessels commonly without detection of abnormalities in the coronary microcirculation but it leaves big number of sufferers with ischemia undiagnosed. CMD and SVD represent a spectrum of functional and structural alterations in coronary microvasculature, manifested as defective vasodilatory response, endothelial dysfunction, inflammation, and small vessel rarefaction resulting in compromised myocardial perfusion. The etiology of CMD and SVD are multifactorial. Endothelial dysfunction and oxidative strain and inflammation disrupt finely tuned regulation of vascular tone but structural remodelling of even the arterioles can reduce perfusion to the heart by reduction in capillary density. These microvascular abnormalities frequently are associated with conventional cardiovascular risk components in addition to high blood pressure, diabetes mellitus, and dyslipidaemia; but they can also seem in the absence of simple danger elements on occasion as unmarried phenomenon broadening the understanding of their complicated etiology.

Novel non-invasive imaging technologies that have revolutionized the assessment of CMD and SVD have been classified together with invasive pressure echocardiography; cardiac magnetic resonance (CMR) imaging with perfusion mapping; and positron emission tomography for the assessment of myocardial blood flow, coronary flow reserve or microvascular function [all representing functional as opposed to anatomical image] as the latest generation of testing. These possess high sensitivity and specificity in the identification of microvascular ischemia, with their top achievements being risk stratification as well as selection of healing and evaluation of therapy efficacy. Invasive methods such as intracoronary Doppler flow volume and thermodilution technique for volume resolution are also good methods to show coronary anatomy in the given patient. CMD/SVD Proper knowledge of diagnosis and therapy. Patients with diffuse microvascular disorder have a significantly prolonged risk of adverse cardiovascular events, such as heart failure with preserved ejection fraction, recurrent angina, and myocardial infarction without or with severe epicardial stenosis. The current treatment consists of management of behavioral risk factors and a combination of optimal antianginal therapy together with pharmacological agents that target the endothelium and microvasculature (statins, ACE-inhibitors, beta-blockers), in addition to the new vasodilatory substances. Diagnosing these types of patients could be better if the molecular mechanisms and new healing marketers were researched.

This assessment extensively critiques the area of CMD and SVD, highlighting knowledge gathering through both invasive and non-invasive diagnostic methods; understanding pathophysiology and clinical implications. In that scenario, a definite part of the game would be, early personalized and targeted therapy as well as the protracted cardiac outcome with the successful identification of coronary microvascular disease without diagnostic delay. The review is intended to throw current tendencies in imaging and treatment, thus elevating the interest of the teaching clinicians, bench researchers and payees around the changing microvascular coronary disease landscape and its present-day scientific cardiology relevance.