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The Role of Coronary Microvascular Dysfunction in Heart Failure With Preserved Ejection Fraction
Andreas Tzoumas1, Danielle Tapp2, Daniela Crousillat3
1University of Cincinnati Medical Center, Division of Cardiovascular Health and Disease, Cincinnati, Ohio, USA; Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA.
JACC. Advances
|November 20, 2025
Summary
Heart failure with preserved ejection fraction (HFpEF) is common and deadly. Coronary microvascular dysfunction (CMD) drives HFpEF progression, yet remains underdiagnosed, limiting treatment options.
Area of Science:
- Cardiology
- Cardiovascular Research
- Internal Medicine
Background:
- Heart failure with preserved ejection fraction (HFpEF) affects millions globally, with limited therapeutic options due to complex pathophysiology.
- Coronary microvascular dysfunction (CMD) is increasingly recognized as a key driver in HFpEF development and progression.
- CMD is highly prevalent in HFpEF patients without obstructive epicardial coronary artery disease and is linked to adverse outcomes.
Purpose of the Study:
- To review the prognostic significance of coronary microvascular dysfunction (CMD) in heart failure with preserved ejection fraction (HFpEF).
- To elucidate the pathophysiologic links between CMD and HFpEF.
- To explore the role of CMD in current and future therapeutic interventions for HFpEF.
Main Methods:
- Literature review of studies investigating coronary microvascular dysfunction (CMD) in heart failure with preserved ejection fraction (HFpEF).
- Analysis of the prevalence, diagnostic challenges, and prognostic implications of CMD in HFpEF.
- Synthesis of evidence on the pathophysiologic mechanisms connecting CMD and HFpEF.
- Evaluation of therapeutic strategies targeting CMD in HFpEF.
Main Results:
- Coronary microvascular dysfunction (CMD) is a significant independent predictor of adverse outcomes in heart failure with preserved ejection fraction (HFpEF).
- CMD contributes to HFpEF pathophysiology through mechanisms including impaired coronary flow reserve, increased myocardial workload, and altered cardiac metabolism.
- Despite its prevalence and prognostic importance, CMD is frequently underdiagnosed in HFpEF patients.
Conclusions:
- Coronary microvascular dysfunction (CMD) is a critical pathophysiologic component of heart failure with preserved ejection fraction (HFpEF) with significant prognostic implications.
- A deeper understanding of the CMD-HFpEF relationship is essential for developing effective, targeted therapeutic strategies.
- Future research and clinical practice should focus on improving the diagnosis and management of CMD in HFpEF patients.
Keywords:
CMDHFpEFcoronary microvascular dysfunctionheart failure with preserved ejection fractionsex-differencesMore Related Videos
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