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Updated: May 11, 2025
Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
Published on: August 17, 2022
Coronary microvascular dysfunction and its role in heart failure with preserved ejection fraction for future
Rachel M Bond1,2, Kendra Ivy3,4, Tre'Cherie Crumbs4,5
1System Director of Women's Heart Health, Dignity Health, Chandler, AZ, USA.
Insights
Coronary microvascular dysfunction (CMD) contributes to heart failure with preserved ejection fraction (HFpEF). Understanding CMD
Area of Science:
- Cardiology
- Cardiovascular Pathophysiology
- Microvascular Medicine
Background:
- Ischemic heart disease is a primary cause of heart failure, linked to obstructive coronary anatomy.
- Coronary microvascular dysfunction (CMD) is increasingly recognized in heart failure with preserved ejection fraction (HFpEF), though clinical evidence is limited.
- Common HFpEF risk factors like diabetes, obesity, and hypertension promote inflammation and endothelial dysfunction, contributing to CMD.
Purpose of the Study:
- To review the current data linking coronary microvascular dysfunction (CMD) to heart failure with preserved ejection fraction (HFpEF).
- To explore the pathophysiologic mechanisms of CMD beyond myocardial ischemia in HFpEF.
- To consider the influence of biopsychosocial factors on disparate health outcomes in CMD and HFpEF.
Main Methods:
- Literature review addressing the current data landscape.
- Analysis of pathophysiologic mechanisms.
- Consideration of biopsychosocial elements and social determinants of health.
Main Results:
- Conventional risk factors for HFpEF foster a pro-inflammatory state conducive to endothelial dysfunction and CMD.
- CMD leads to impaired coronary blood flow and transient ischemia, impacting cardiovascular mechanisms.
- CMD presents distinct prevention and treatment targets for HFpEF patients.
Conclusions:
- Coronary microvascular dysfunction (CMD) is a significant factor in heart failure with preserved ejection fraction (HFpEF) development and progression.
- CMD offers novel therapeutic targets for HFpEF management.
- Biopsychosocial factors significantly influence the disparate health outcomes associated with CMD and HFpEF.
Abstract:
Ischemic heart disease has long been established as the leading cause of heart failure, typically as a result of hemodynamically significant and obstructive coronary anatomy. Since, the role of dysfunctional coronary microvascular pathophysiologic mechanisms have also been associated with the development of congestive heart failure (CHF), most notably heart failure with preserved ejection fraction (HFpEF) although with limited clinical evidence. Conventional cardiometabolic and behavioral risk factors common to HFpEF such as diabetes mellitus (DM), obesity, hypertension, dyslipidemia, smoking, and chronic kidney disease foster a pro-inflammatory environment conducive to endothelial dysfunction and improper regulation of vasoactive substances. The impaired relaxation and increased vasoconstriction of damaged endothelium gives rise to impaired coronary blood flow and episodes of transient ischemia. Such coronary microvascular dysfunction (CMD) has its own implication on cardiovascular pathophysiologic mechanisms beyond symptomatic coronary and myocardial ischemia, and thus its own potential prevention goals and treatment targets for patients with HFpEF, where previous management had been limited. As such, we conducted a literature review to address the current landscape of data which links CMD to HFpEF. Furthermore, we considered the implications of biopsychosocial elements such as race, ethnicity, sex, gender, and the social determinants of health as they relate to the disparate health outcomes of those most at risk for CMD and HFpEF.
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