# Exploring coronary microvascular dysfunction from functional impairment and structural damage

## TL;DR

This review explores how coronary microvascular dysfunction causes heart issues and emphasizes the need for better understanding of its causes to improve diagnosis and treatment.

## Contribution

The paper provides a systematic review of CMD's pathophysiology, focusing on functional and structural aspects to guide future clinical innovations.

## Key findings

- CMD is linked to heart failure with preserved ejection fraction.
- CMD involves both functional and structural impairments of the coronary microvasculature.
- CMD subtypes show diverse clinical and hemodynamic features due to underlying pathophysiological heterogeneity.

## Abstract

Coronary microvascular dysfunction (CMD) is a syndrome characterized by myocardial ischemia resulting from structural and/or functional impairments of the coronary microvasculature, which includes pre-arterioles, arterioles, and capillaries. It has taken center stage in cardiovascular research due to its established role in triggering heart failure with preserved ejection fraction (HFpEF). The pathogenesis of CMD is closely associated with endothelial dysfunction, characterized by both structural and functional impairment of endothelial cells. This interplay between functional and structural injury underlies the significant heterogeneity in clinical phenotypes and hemodynamic characteristics across CMD subtypes, thus highlighting the necessity for a multidimensional investigation of its underlying pathological mechanisms. This review article systematically elaborates the pathophysiological features of CMD with a focus on two dimensions: microcirculatory functional regulation and vascular structural remodeling, aiming to provide a theoretical foundation for innovations in clinical diagnosis and treatment strategies.