The Spectrum of Microvascular Obstruction in Nonischemic Cardiomyopathy

Chern Hsiang Choy, Richard P. Steeds, Francisco Leyva, William E. Moody*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Microvascular obstruction (MVO) is a commonly described complication of coronary reperfusion therapy following a prolonged period of myocardial ischaemia. 1 It is typified by damage and dysfunction of the myocardial microvasculature resulting in a no-reflow phenomenon, where blood flow beyond the myocardial capillary bed is impaired. The emergence of cardiovascular magnetic resonance (CMR) quantitative perfusion mapping has established a robust graded association between left ventricular hypertrophy and microvascular dysfunction. To date, however, MVO as an entity has been underreported outside the setting of acute myocardial infarction. 2 In this vignette, we present CMR imaging examples of MVO in a series of patients with unobstructed coronaries but with left ventricular hypertrophy sufficient to cause structural damage to the microvasculature, resulting in chronic impairment of blood flow to the cardiac myocytes (Figures 1 to 4).

Although the presence of MVO on CMR following acute coronary syndrome is an independent predictor of major adverse cardiovascular events and mortality, 1 further research is needed into whether MVO confers a similarly elevated risk among patients with nonischemic cardiomyopathy.
Original languageEnglish
Pages (from-to)2139-2144
Number of pages6
Journal JACC: Cardiovascular Imaging
Issue number12
Early online date14 Sept 2022
Publication statusPublished - Dec 2022


  • cardiac magnetic resonance
  • cardiomyopathy
  • microvascular obstruction


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