Coronary microvascular dysfunction in angina and non-obstructive coronary arteries: Pathophysiology, diagnosis, novel markers and therapy.

Coronary microvascular dysfunction encompasses a wide variety of structural and/or functional abnormalities of the coronary microcirculation which are key determinants of myocardial ischemia in patients with angina and non-obstructive coronary artery disease, as well as in several other cardiovascular conditions. The diagnosis is based on the demonstration of an impaired vasodilator capacity and/or the evidence of microvascular spasm by invasive coronary angiography. Despite its relevant clinical and prognostic implications, there are no specific treatments to date specifically addressing coronary microvascular dysfunction. In this review article, we aimed to provide an overview of the pathophysiology, diagnostic work-up, and therapeutic management of patients with angina and non-obstructive coronary artery disease, focusing on emerging biomarkers, novel therapeutic targets, and remaining knowledge gaps and unmet needs.