REVIEW Clinical update Coronarymicrovascular dysfunction: an update

Many patients undergoing coronary angiography because of chest pain syndromes, believed to be indicative of obstructive atherosclerosis of the epicardial coronary arteries, are found to have normal angiograms. In the past two decades, a numberof studies have reported that abnormalities in the function and structure of the coronarymicrocirculationmay occur in patients without obstructive atherosclerosis, but with risk factors or withmyocardial diseases as well as in patients with obstructive atherosclerosis; furthermore, coronarymicrovascular dysfunction (CMD) can be iatrogenic. In some instances, CMD represents an epiphenomenon, whereas in others it is an importantmarker of risk ormay even contribute to the pathogenesis of cardiovascular and myocardial diseases, thus becoming a therapeutic target. This review article provides an update on the clinical relevance of CMD in different clinical settings and also the implications for therapy