. Author manuscript; available in PMC: 2018 Aug 1.

Published in final edited form as: Circ Cardiovasc Imaging. 2017 Aug;10(8):e006427. doi: 10.1161/CIRCIMAGING.117.006427

Table 2.

Secondary coronary microvascular disease (CMVD) in cardiac diseases.

Disease	Presumed pathophysiology of CMVD	Coronary flow abnormality	Prognostic value of coronary flow parameters	Improvement in CFR with treatment	Reference
Hypertrophic obstructive cardiomyopathy	Remodeling of intramural coronary arterioles, marked wall thickening, luminal narrowing	Reduced hyperemic MBFproportional to hypertrophy	Reduced hyperemic MBF independent predictor of cardiovascular death, progression to heart failure, or sustained ventricular arrhythmias	Alcohol septal ablation	^{62, 103, 104}
Dilated cardiomyopathy	Endothelial dysfunction, decreased microvascular density, extravascular compression of the microvasculature due to elevated LV filling pressures	Reduced CFR present at early stage of the disease	Reduced hyperemic MBF independent predictor of cardiac death or development/progression of heart failure	CRT	^105–109
Dilated cardiomyopathy		Reduced CFR present at early stage of the disease	Preserved CFR independent predictor of LV recovery in response to CRT	CRT	^105–109
Heart failure with preserved ejection fraction	Systemic pro-inflammatory state leading to coronary microvascular endothelial inflammation, lower coronary microvascular density	Reduced CFR			^110–113
Aortic stenosis	Increased hemodynamic load leading to increased LV mass, reduction in diastolic perfusion time, and abnormal cardiac-coronary coupling	Reduced hyperemic flow correlating to stenosis severity		Conventional or transcatheter aortic valve replacement	^114–116
Coronary allograft vasculopathy	Generalized endothelial dysfunction, diffuse concentric epicardial intimal thickening with CMVD secondary to changes in sympathetic innervation, inflammation, and autoimmune mechanisms	Reduced CFR correlating with intimal thickening	Reduced CFR and hyperemic MBF predictors of adverse events (all-cause death, acute coronary syndrome and heart failure hospitalization)		^{117, 118}
Amyloidosis	Diffuse coronary media infiltration or obstruction of intramyocardial coronary vessels by amyloid deposits	Reduced rest MBF, reduced hyperemic MBF, reduced CFR			¹¹⁹
Sarcoidosis	Microvascular compression by inflammation or granulomas	Reduced hyperemic MBF corresponding to areas of inflammation		Immune-suppression	⁷⁴

Abbreviations: MBF: myocardial blood flow, CFR: coronary flow reserve, LV: left ventricle, CRT: cardiac resynchronization therapy