Abstract

It is widely recognized that endothelial dysfunction   that   is   caused   by   diabetes in various vascular beds contributes to a wide range of complications and exerts unfavorable effects on microcirculatory regulation. The coronary   microcirculation is precisely regulated through a number of interconnected physiological processes with the   purpose   of   matching   local blood flow to myocardial metabolic demands. Dysregulation of this network might contribute to varying degrees of pathological consequences.   Diabetic patients are frequently affected by coronary microvascular dysfunction (CMD), a condition consisting of a combination of altered vasomotion and long-term structural change   to    coronary    arterioles    leading to impaired regulation of blood flow in response to changing cardiomyocyte oxygen requirements. The pathogenesis of this microvascular complication is complex and not completely known, involving several alterations among which hyperglycemia and insulin resistance play particularly central roles leading to oxidative stress, inflammatory activation and altered barrier function of endothelium. CMD significantly contributes to cardiac events such as angina or infarction without obstructive coronary artery disease, as well as heart failure, especially the phenotype associated with preserved ejection fraction, which greatly impact cardiovascular (CV) prognosis. Diagnosis of Coronary Microvascular Dysfunction in diabetic patients by using non-invasive and invasive diagnostic and research procedures.