Myocardial ischemia constitutes one of the most important pathophysiological features in hypertrophic cardiomyopathy. Chronic and recurrent myocardial ischemia leads to fibrosis, which may culminate in myocardial dysfunction. Since the direct visualization of coronary microcirculation in vivo is not possible, its function must be studied indirectly. Invasive and noninvasive techniques allow microcirculatory dysfunction to be evaluated, including echocardiography, magnetic resonance, positron emission tomography, and cardiac catheterization. Blunted myocardial blood flow and coronary flow reserve have been suggested to associate with unfavorable prognosis. Microcirculatory dysfunction may be one additional important parameter to take into account for risk stratification beyond the conventional risk factors.

中文翻译：

---

肥厚型心肌病的冠状动脉微血管功能障碍：病理生理学、评估和临床影响

心肌缺血是肥厚型心肌病最重要的病理生理特征之一。慢性和复发性心肌缺血导致纤维化，最终可能导致心肌功能障碍。由于体内冠状动脉微循环的直接可视化是不可能的，因此必须间接研究其功能。有创和无创技术可以评估微循环功能障碍，包括超声心动图、磁共振、正电子发射断层扫描和心导管术。已表明心肌血流减弱和冠状动脉血流储备与不良预后相关。微循环功能障碍可能是除传统风险因素之外的另一个重要参数，需要考虑风险分层。