REVIEW article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Exploring coronary microvascular dysfunction from functional impairment and structural damage
Provisionally accepted
- 1Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- 2People's Hospital of Xiangzhou District, Zhuhai, China
- 3Inner Mongolia Autonomous Region Traditional Chinese Medicine Hospital, Hohhot, Inner Mongolia Autonomous Region, China
- 4Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, China
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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.
Keywords: Coronary microvascular dysfunction, functional impairment, Structural damage, Ischemic Heart Disease, Coronary flow reserve, Index of microcirculatory resistance
Received: 27 Mar 2025; Accepted: 03 Nov 2025.
Copyright: © 2025 Wen, Zhang, Zhang, Jia and Yi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Chi Yi, cywwtougao@sina.com
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