Coronary Artery Disease in Heart Failure With Preserved Ejection Fraction

Area of Science:

• Cardiology
• Heart Failure Research
• Ischemic Heart Disease

Background:

• Coronary artery disease (CAD), encompassing epicardial and microvascular dysfunction (CMD), is a major factor in heart failure with preserved ejection fraction (HFpEF).
• CAD presence correlates with adverse outcomes, myocardial remodeling, and progression to reduced ejection fraction.
• Coronary microvascular dysfunction (CMD), more common in women, compromises myocardial perfusion and energetics, causing exercise intolerance and increased filling pressures.

Purpose of the Study:

• To highlight the significance of ischemic phenotypes in heart failure with preserved ejection fraction (HFpEF).
• To emphasize the role of coronary artery disease (CAD) in HFpEF pathophysiology and outcomes.
• To discuss diagnostic and therapeutic considerations for CAD in HFpEF.

Main Methods:

• Review of current literature on coronary artery disease (CAD) and heart failure with preserved ejection fraction (HFpEF).
• Discussion of emerging treatments like SGLT2 inhibitors and finerenone for HFpEF phenotypes with ischemia.
• Emphasis on multimodal diagnostic techniques for identifying subclinical CAD and CMD.

Main Results:

• Coronary artery disease (CAD) is a key driver of HFpEF, linked to poorer prognosis and disease progression.
• Coronary microvascular dysfunction (CMD) specifically impairs heart function and leads to symptoms like exercise intolerance.
• Novel therapies show promise across various HFpEF types, including those with ischemic components.

Conclusions:

• Recognizing ischemic patterns in HFpEF is vital for accurate risk stratification and guiding treatment decisions.
• Multimodal diagnostics are essential for detecting CMD and subclinical CAD.
• Future research should explore phenotype-specific approaches to enhance outcomes in heterogeneous HFpEF populations.