Coronary microvascular dysfunction in the setting of cardiac and systemic clinical conditions
This article provides an interesting follow-up to the 1st webinar of the Angina Updates initiative. In this review by RE Konst et al. (Including Prof Kaski, one of our editors), explain very elegantly how different factors are involved in coronary microvascular dysfunction. They include dynamic, structural factors, and functional factors that contribute to the occurrence of CMD. Endothelial dysfunction and vascular smooth muscle cell dysfunction are caused by (often a combination of) structural and/or functional factors. In addition, CMD plays a pathogenic role in cardiac and systemic conditions other than microvascular angina.
The authors provide an overview of the pathogenic role of CMD in the setting of a wide variety of cardiac and systemic clinical conditions (diabetes mellitus, obesity, hypertensive pregnancy disorders, chronic inflammatory and autoimmune rheumatic disorders, chronic kidney disease, hypertrophic cardiomyopathy, and aortic valve stenosis).
Take-home message: In the clinical conditions described in this article, coronary microvascular dysfunction is consistently associated with myocardial ischaemia and portrays an increased risk for cardiovascular events. CMD is often detectable very early in the course of the primary disease, before clinical symptoms or signs of myocardial ischaemia are present.