Although myocardial ischaemia usually manifests as a consequence of atherosclerosis-dependent obstructive epicardial coronary artery disease,a significant percentage of patients suffer ischaemic events in the absence of epicardial coronary artery obstruction.Experimental and clinical evidence highlight the abnormalities of the coronary microcirculation as a main cause of myocardial ischaemia in patients with‘normal or near normal’coronary arteries on angiography.Coronary microvascular disturbances have been associated with early stages of atherosclerosis even prior to any angiographic evidence of epicardial coronary stenosis,as well as to other cardiac pathologies such as myocardial hypertrophy and heart failure.The main objectives of the manuscript are(i)to provide updated evidence in our current understanding of the pathophysiological consequences of microvascular dysfunction in the heart;(ii)to report on the current knowledge on the relevance of cardiovascular risk factors and comorbid conditions for microcirculatory dysfunction;and(iii)to evidence the relevance of the clinical consequences of microvascular dysfunction.Highlighting the clinical importance of coronary microvascular dysfunction will open the field for research and the development of novel strategies for intervention will encourage early detection of subclinical disease and will help in the stratification of cardiovascular risk in agreement with the new concept of precision medicine.

尽管心肌缺血通常表现为动脉粥样硬化依赖性阻塞性心外膜冠状动脉疾病的结果，但在没有心外膜冠状动脉阻塞的情况下，仍有相当大比例的患者发生缺血事件。实验和临床证据强调冠状动脉微循环异常是血管造影显示的“正常或接近正常”冠状动脉患者心肌缺血的主要原因。即使在任何心外膜冠状动脉狭窄的血管造影证据之前，冠状动脉微血管紊乱也与动脉粥样硬化的早期阶段相关，以及与其他心脏病理如心肌肥大和心力衰竭相关。手稿的主要目的是 (i) 为我们目前对心脏微血管功能障碍的病理生理学后果的理解提供更新的证据；(ii) 报告关于心血管风险因素和微循环功能障碍合并症相关性的现有知识；和 (iii) 证明微血管功能障碍的临床后果的相关性。强调冠状动脉微血管功能障碍的临床重要性将为研究打开领域，开发新型干预策略将鼓励早期检测亚临床疾病，并将有助于心血管风险分层，与精准医学的新概念一致。