Coronary microvascular dysfunction: pathophysiology, diagnosis, and therapeutic strategies across cardiovascular diseases

Authors

  • Vincenzo Scarica Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy https://orcid.org/0009-0000-1858-9595
  • Riccardo Rinaldi Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Cardiology Unit, Infermi Hospital, Rimini, Italy https://orcid.org/0000-0003-0559-2626
  • Francesco Maria Animati Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy https://orcid.org/0009-0008-5441-9276
  • Matteo Manzato Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy https://orcid.org/0009-0001-9080-2183
  • Rocco Antonio Montone Department of Cardiovascular Sciences, Fondazione Policlinico A. Gemelli IRCCS, L.go A. Gemelli, 1 – 00168 Rome, Italy. Tel. +39-06-30154187; Fax. +39-06-3055535, E-mail: roccoantonio.montone@unicatt.it https://orcid.org/0000-0002-6439-1018

DOI:

https://doi.org/10.17179/excli2025-8285

Keywords:

coronary microvascular dysfunction, INOCA, ANOCA, coronary spasm, precision medicine

Abstract

Ischemic heart disease (IHD) is a leading cause of morbidity and mortality worldwide, presenting with acute and chronic coronary syndromes. Although coronary atherosclerosis is a major cause of IHD, many patients with angina or myocardial ischemia do not have obstructive coronary heart disease and impairment of the coronary microcirculation has been increasingly implicated as a relevant cause of IHD. Therefore, coronary microvascular dysfunction (CMD) refers to a term covering a wide spectrum of structural and functional alterations which affect the coronary microcirculation leading to myocardial ischemia and angina. The advent of non-invasive and invasive functional tests has exponentially broadened the ability to recognize CMD and delineate related clinical and biochemical features. Despite major advances in diagnosing and stratifying this condition, therapeutic strategies remain limited and poorly defined. In this review, we will provide an overview of the pathophysiology and the diagnostic evaluation of CMD across the spectrum of cardiovascular diseases. Furthermore, we will discuss the novel therapeutic strategies available for these patients in the perspective of a personalised medicine approach.

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Published

2025-03-26

How to Cite

Scarica, V., Rinaldi, R., Animati, F. M., Manzato, M., & Montone, R. A. (2025). Coronary microvascular dysfunction: pathophysiology, diagnosis, and therapeutic strategies across cardiovascular diseases. EXCLI Journal, 24, 454–478. https://doi.org/10.17179/excli2025-8285

Issue

Vol. 24 (2025)

Section

Review articles

Categories

License

Copyright (c) 2025 Vincenzo Scarica, Riccardo Rinaldi, Francesco Maria Animati, Matteo Manzato, Rocco Antonio Montone

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