Coronary microvascular dysfunction and heart failure with preserved ejection fraction: what are the mechanistic links?

IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Current Opinion in Cardiology Pub Date : 2023-11-01 Epub Date: 2023-08-28 DOI:10.1097/HCO.0000000000001082
Aish Sinha, Haseeb Rahman, Divaka Perera
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Abstract

Purpose of review: Heart failure with preserved ejection fraction (HFpEF) accounts for half of all heart failure presentations and is associated with a dismal prognosis. HFpEF is an umbrella term that constitutes several distinct pathophysiological entities. Coronary microvascular dysfunction (CMD), defined as the inability of the coronary vasculature to augment blood flow adequately in the absence of epicardial coronary artery disease, is highly prevalent amongst the HFpEF population and likely represents one distinct HFpEF endotype, the CMD-HFpEF endotype. This review appraises recent studies that have demonstrated an association between CMD and HFpEF with an aim to understand the pathophysiological links between the two. This is of significant clinical relevance as better understanding of the pathophysiology underlying CMD-HFpEF may result in more targeted and efficacious therapeutic options in this patient cohort.

Recent findings: There is a high prevalence of CMD, diagnosed invasively or noninvasively, in patients with HFpEF. Patients with HFpEF who have an impaired myocardial perfusion reserve (MPR) have a worse outcome than those with a normal MPR. Both MPR and coronary flow reserve (CFR) are associated with measures of left ventricular diastolic function and left ventricular filling pressures during exercise. Impaired lusitropy and subendocardial ischaemia link CMD and HFpEF mechanistically.

Summary: CMD-HFpEF is a prevalent endotype of HFpEF and one that is associated with adverse cardiovascular prognosis. Whether CMD leads to HFpEF, through subendocardial ischaemia, or whether it is secondary to the impaired lusitropy that is characteristic of HFpEF is not known. Further mechanistic work is needed to answer this pertinent question.

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射血分数保留的冠状动脉微血管功能障碍和心力衰竭:机制联系是什么?
综述目的:射血分数保留的心力衰竭(HFpEF)占所有心力衰竭表现的一半,并与预后不佳有关。HFpEF是一个总括性术语,由几个不同的病理生理实体组成。冠状动脉微血管功能障碍(CMD),定义为在没有心外膜冠状动脉疾病的情况下,冠状血管系统不能充分增加血流量,在HFpEF人群中非常普遍,可能代表一种不同的HFpEF内型,即CMD-HFpEF内型。这篇综述评估了最近的研究,这些研究证明了CMD和HFpEF之间的相关性,目的是了解两者之间的病理生理联系。这具有重要的临床意义,因为更好地了解CMD HFpEF的病理生理学可能会在该患者队列中产生更具针对性和有效的治疗选择。最近的发现:在HFpEF患者中,无论是侵袭性诊断还是非侵袭性诊断,CMD的患病率都很高。心肌灌注储备(MPR)受损的HFpEF患者的预后比MPR正常的患者差。MPR和冠状动脉血流储备(CFR)都与运动期间左心室舒张功能和左心室充盈压的测量有关。软质受损和心内膜下缺血在机制上与CMD和HFpEF有关。总结:CMD HFpEF是一种常见的HFpEF内型,与心血管不良预后有关。CMD是否通过心内膜下缺血导致HFpEF,或者它是否继发于HFpEF特有的软性受损,目前尚不清楚。需要进一步的机械化工作来回答这个相关的问题。
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来源期刊
Current Opinion in Cardiology
Current Opinion in Cardiology 医学-心血管系统
CiteScore
4.20
自引率
4.30%
发文量
78
审稿时长
6-12 weeks
期刊介绍: ​​​​​​Current Opinion in Cardiology is a bimonthly publication offering a unique and wide ranging perspective on the key developments in the field. Each issue features hand-picked review articles from our team of expert editors. With fourteen disciplines published across the year – including arrhythmias, molecular genetics, HDL cholesterol and clinical trials – every issue also contains annotated reference detailing the merits of the most important papers.
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