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Microvascular dysfunction (mvD), and more specifically coronary microvascular disease (CMD), has been implicated as the primary hallmark of diabetic cardiomyopathy and HFpEF, afflicting millions of people worldwide. The onset and progression of microvascular disease is driven by vascular inflammation and is characterized by vascular smooth muscle cell thickening and impaired vasomodulation, both of which ultimately reduce perfusion and damage tissue. To meet metabolic demands, the body recruits additional assistance from our microvascular reserve, which is diminished during stress, thus resulting in a dampened vasomodulatory response to stimuli. Diagnosing mvD in the myocardium, therefore, requires a non-invasive method to measure vasomodulation or, more precisely, changes in microvascular blood volume.

Current clinical imaging …