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The spectrum and systemic associations of microvascular dysfunction in the heart and other organs

Nature Cardiovascular Research volume 1, pages 298–311 (2022)Cite this article

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Abstract

Microvascular dysfunction (MVD) contributes to several conditions that increase morbidity and mortality, including ischemic heart disease, heart failure, dementia, chronic kidney disease and hypertension. Consequently, MVD imposes a substantial burden on healthcare systems worldwide. In comparison to macrovascular dysfunction, MVD has been incompletely investigated, and it remains uncertain whether MVD in an organ constitutes a distinct pathology or a manifestation of a systemic disorder. Here, we summarize and appraise the techniques that are used to diagnose MVD. We review the disorders of the heart, brain and kidneys in which the role of MVD has been highlighted and summarize evidence hinting at a systemic or multi-organ nature of MVD. Finally, we discuss the benefits and limitations of implementing MVD testing in clinical practice with a focus on new interventions that are beginning to emerge.

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Fig. 1: Risk factors and manifestations of MVD.
Fig. 2: Diagnostic techniques to assess microcirculation in different organ systems.
Fig. 3: Diagnosis of INOCA endotypes.
Fig. 4: Coexistence of microvascular disease in organs other than the heart.

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  1. These authors contributed equally: Maria Emfietzoglou, Dimitrios Terentes-Printzios.

Authors and Affiliations

  1. Oxford Heart Centre, Oxford University Hospitals, Oxford, UK

    Maria Emfietzoglou, Dimitrios Terentes-Printzios, Rafail A. Kotronias, Federico Marin, Claudio Montalto, Giovanni Luigi De Maria & Adrian P. Banning

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M.E., D.T.-P., R.A.K., F.M., C.M., G.L.D.M. and A.P.B. actively participated in the conception of the review, drafting and revising the manuscript critically for important intellectual content and final approval of the published text.

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Emfietzoglou, M., Terentes-Printzios, D., Kotronias, R.A. et al. The spectrum and systemic associations of microvascular dysfunction in the heart and other organs. Nat Cardiovasc Res 1, 298–311 (2022). https://doi.org/10.1038/s44161-022-00045-5

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