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September 3, 2026Journal of Cardiovascular Development and DiseaseOpen Access

Invasive coronary function testing provides a physiology-based framework for assessing coronary microvascular dysfunction.

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Design

Review

Key result

Invasive coronary function testing provides a physiology-based framework for assessing coronary microvascular dysfunction, supporting a shift toward a mechanism-based approach.

Authors

DSDivyansh SharmaDBDaniel BishevSCShudipan Chakraborty

Discussion

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Overview

Supports invasive functional testing to differentiate microvascular endotypes; leaves open prospective outcome trials before routine adoption.

Key Points

  • To provide a physiology-based framework summarizing the biological foundations, clinical phenotypes, and invasive diagnostic tools for coronary microvascular dysfunction across ischemic heart disease syndromes.
  • Synthesized pathophysiological mechanisms underlying microvascular impairment, including endothelial dysfunction, smooth muscle hyperreactivity, and structural remodeling.
  • Evaluated invasive functional diagnostic tools, specifically coronary flow reserve, index of microcirculatory resistance, and intracoronary acetylcholine vasomotor provocation testing in acute and stable coronary syndromes.
  • Coronary microvascular dysfunction drives myocardial ischemia across nonobstructive coronary disease, persistent post-revascularization angina, and acute coronary syndromes via distinct endotypes.
  • Invasive functional assessment combining coronary flow reserve, microcirculatory resistance, and vasoreactivity testing differentiates functional vasomotor disorders from structural microvascular disease and post-infarction injury.

PICO

P
Population
Coronary microvascular dysfunction
I
Intervention / Comparator
Invasive coronary function testing

This review advocates for a shift from purely anatomic assessment to a mechanism-based, physiology-driven approach using invasive coronary function testing for patients with ischemic heart disease.

Cite This Study

Sharma et al. (2026) conducted a review in Coronary microvascular dysfunction. Invasive coronary function testing was evaluated. Invasive coronary function testing provides a physiology-based framework for assessing coronary microvascular dysfunction, supporting a shift toward a mechanism-based approach.

synapsesocial.com/papers/6a993592636c6408cfa7def5https://doi.org/10.3390/jcdd13090426
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