The role of coronary microcirculation in heart failure with preserved ejection fraction: An unceasing odyssey

Area of Science:

• Cardiology
• Cardiovascular Research

Background:

• Heart failure with preserved ejection fraction (HFpEF) has complex causes.
• Coronary microvascular dysfunction (CMD) is increasingly recognized as a significant contributor to HFpEF.
• CMD involves impaired vasoreactivity, capillary loss, and inflammation.

Purpose of the Study:

• To explore the role of coronary microvascular dysfunction (CMD) in heart failure with preserved ejection fraction (HFpEF).
• To review diagnostic methods for CMD in HFpEF patients.
• To discuss potential therapeutic strategies for CMD in HFpEF.

Main Methods:

• Review of noninvasive diagnostic techniques for CMD, including echocardiography, cardiac MRI, and PET.
• Inclusion of invasive assessment methods like coronary flow reserve and index of microcirculatory resistance.
• Analysis of existing literature on the association between CMD and HFpEF prognosis and treatment.

Main Results:

• CMD is frequently observed in patients with HFpEF.
• The presence of both CMD and HFpEF is linked to a worse prognosis.
• Limited evidence suggests potential benefits from renin-angiotensin-aldosterone system inhibitors, ranolazine, and SGLT2 inhibitors for CMD.

Conclusions:

• CMD is a critical pathophysiological component of HFpEF.
• Accurate diagnosis of CMD is essential for managing HFpEF.
• Further research is needed to establish effective pharmacotherapies for CMD, including anti-inflammatory agents.