A significant percentage of patients suffer ischaemic events in the absence of epicardial coronary artery obstruction. Coronary microvascular dysfunction (CMD) refers to a term covering a wide spectrum of clinical situations in which the structure and function of the coronary microcirculation is affected.The abnormalities of the coronary microcirculation are a main cause of myocardial ischaemia in patients with ‘normal or near normal’ coronary arteries on angiography. Coronary microvascular disturbances have been associated with early stages of atherosclerosis, as well as to other cardiac pathologies such as myocardial hypertrophy and heart failure.
The objective of the present position paper of the European Society of Cardiology (ESC) Working Group on Coronary Pathophysiology and Microcirculation by T. Padro et al. (Autonomous University Barcelona, Spain) is to provide updated evidence and a critical view of the pathophysiology of microvascular dysfunction in association with ischaemic heart disease. Take-home message: Coronary microvascular dysfunction is highly prevalent. Developing therapeutic interventions to reverse functional abnormalities in coronary resistance vessel control is important for the management of ischaemic heart disease.