Myocardial ischemia and coronary microcirculation (CMD)

Myocardial ischemia and coronary microcirculation refers to a pathological state and a physiological system rather than a single molecular target. Myocardial ischemia occurs when the blood supply to the heart muscle is insufficient to meet its metabolic demands, often resulting from obstructive coronary artery disease or coronary microvascular dysfunction (CMD) (Heusch, 2013). The coronary microcirculation consists of pre-arterioles, arterioles, and capillaries that regulate the majority of coronary vascular resistance and ensure adequate nutrient exchange (Camici & Crea, 2007). In many patients, ischemia occurs due to the inability of these microvessels to dilate properly, even in the absence of large-vessel blockages (Crea et al., 2014). This condition is a key driver of microvascular angina and is increasingly recognized in patients with heart failure with preserved ejection fraction (HFpEF) (Ford et al., 2018). Therapeutic strategies focus on improving microvascular function and reducing oxygen demand through various classes of drugs, including vasodilators and metabolic modulators (Ong et al., 2018).

Other names

Coronary microvascular dysfunction (CMD)Microvascular anginaCardiac syndrome XSmall vessel disease of the heart

Pharmacological interventions typically aim to reduce myocardial oxygen demand, enhance coronary vasodilation, or improve endothelial function to alleviate ischemia (Ong et al., 2018; Camici & Crea, 2007).