Pathophysiology of Coronary Microcirculation Dysfunction
DOI:
https://doi.org/10.52692/1857-0011.2025.1-81.08Keywords:
coronary microcirculation dysfunction, endothelial dysfunction, microvascular spasm, microthrombosis, prognostic biomarkersAbstract
Coronary microcirculation dysfunction (CMD) comprises functional and structural alterations that impede blood flow through the arteriolarcapillary network of the heart. Three pathophysiological patterns have been recognised:(1) impaired microvascular vasodilation, (2) enhanced vasoconstrictor tone, and (3) diffuse microthrombosis. CMD acts both as an ischaemic substrate and as a consequence of reperfusion, being highly prevalent in STEMI/NSTEMI, explaining ischaemia/angina without epicardial obstruction (INOCA/ANOCA, MINOCA), and worsening outcomes in heart failure with preserved ejection fraction, atrial fibrillation, and sudden cardiac death. This review highlights core mechanisms - endothelial dysfunction with nitricoxide depletion, hypertrophic remodelling of resistance arterioles, Rhokinase upregulation, and thromboinflammatory imbalance - and details their expression across clinical phenotypes. A comprehensive understanding supports a diagnostic algorithm combining targeted invasive testing (FFR, IMR, acetylcholine/adenosine challenge) with a mult imarker panel (NO, ET1, GDF15, PCSK9, Lp(a), etc.) and paves the way for personalised therapeutic strategies.
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