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Coronary microvascular dysfunction (CMD) contributes significantly to both acute and chronic coronary syndromes, even in the absence of obstructive epicardial disease. Despite its clinical significance, CMD remains underdiagnosed due to the lack of routine assessment in contemporary cardiac catheterization practices. Emerging invasive and noninvasive techniques now enable comprehensive evaluation of coronary microvascular dysfunction (CMD) by assessing microvascular resistance, coronary flow reserve, and tissue-level perfusion. Advances in thermodilution-based indices, intracoronary Doppler, and functional coronary angiography continue to provide quantitative insights into microvascular physiology, whereas noninvasive modalities\u2014including cardiac magnetic resonance (MRI), positron-emitted tomography (PET), transthoracic Doppler echocardiography, and computed tomography-based perfusion imaging\u2014offer powerful tools for diagnosing CMD without the need for catheter-based assessment. Integrating these complementary approaches into clinical practice enhances risk stratification and supports personalized management strategies, particularly in patients with ischemia and nonobstructive coronary arteries (INOCA). This review explores in-depth the diagnostic tools and the quantitative metrics used or the invasive assessment of CMD, emphasizing their clinical utility and impact on patient management.<\/jats:p>","DOI":"10.1152\/ajpheart.00555.2025","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T15:42:38Z","timestamp":1766504558000},"page":"H453-H467","update-policy":"https:\/\/doi.org\/10.1152\/aps-crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Bridging the gap: a comprehensive toolkit for assessment of coronary microcirculation in clinical practice"],"prefix":"10.1152","volume":"330","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9166-3031","authenticated-orcid":false,"given":"Alberto","family":"Polimeni","sequence":"first","affiliation":[{"name":"University of Calabria","place":["Italy"]},{"name":"Annunziata 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