Coronary microvascular dysfunction in cardiovascular disease

The coronary microvasculature is responsible for maintaining local matching of myocardial blood flow to myocardial demand of oxygen and nutrients. Long term adjustment of myocardial blood flow involves structural changes in microvascular density and diameter while fine-tuning of flow is achieved via adaptations in vascular smooth muscle tone in the coronary microvasculature.

In the past several decades, considerable research efforts have been directed at understanding structural and functional microvascular adaptations involved in matching myocardial oxygen supply and demand and how these mechanisms are affected by various diseases. In this review we will discuss our current understanding of the mechanisms underlying the regulation of coronary microvascular tone under healthy physiological conditions, and the role of microvascular dysfunction in obstructive and non-obstructive coronary artery disease, as studied in large animal (particularly swine) models and confirmed in human studies. Future studies should be directed at further unraveling the mechanisms of coronary microvascular dysfunction in different disease entities in order to, and ultimately directed at improving microvascular function as a therapeutic target in patients with ischemic heart disease.