Coronary Microvascular Dysfunction in Systemic Inflammatory Diseases: From Pathophysiology and Prevalence to Diagnosis and Management.

Coronary microvascular dysfunction (CMVD) significantly contributes to increased cardiovascular morbidity and mortality in patients with autoimmune systemic inflammatory diseases. Clinicians should maintain a high index of suspicion for CMVD when discussing cardiovascular symptoms in this patient population. In symptomatic patients without obstructive coronary artery disease, diagnostic evaluation of CMVD should be considered carefully. In this review, we will outline the pathophysiology of CMVD, with an emphasis on the role of inflammation in the development and progression of microvascular disease. We will also review available noninvasive and invasive diagnostic testing for the detection of microvascular disease and discuss evidence-based strategies for managing CMVD in these complex patients.