CNR, Institute of Clinical Physiology, Pisa, Italy.
Ann N Y Acad Sci. 2010 Oct;1207:107-15. doi: 10.1111/j.1749-6632.2010.05724.x.
Heart failure is characterized by a chronic inflammatory status, with high circulating levels of inflammatory cytokines significantly correlated with deterioration of functional capacity, cardiac performance, and coronary flow reserve--the latter occurring even with normal systemic endothelial function. Impaired coronary flow reserve in heart failure is poorly related to systemic inflammation levels and somewhat matched by a reduction in myocardial contractile reserve. Both coronary flow and myocardial functional reserve can be imaged noninvasively and can be useful clinically for disease severity titration, diagnostic anticipation, and prognostic stratification. Coronary microcirculatory dysfunction can be a trigger of disease and a potential target for therapeutic intervention in heart failure patients. Clinical observational studies showed a striking beneficial effect of endogenous adenosine accumulation on symptoms, exercise capacity, and left ventricular function in chronic heart failure, but this needs to be confirmed in prospective randomized large-scale trials.
心力衰竭的特征是慢性炎症状态，循环中高水平的炎症细胞因子与功能能力、心功能和冠状动脉血流储备的恶化显著相关——即使全身内皮功能正常也是如此。心力衰竭患者的冠状动脉血流储备受损与全身炎症水平相关性较差，与心肌收缩储备减少有些匹配。冠状动脉血流和心肌功能储备都可以进行非侵入性成像，并且在疾病严重程度滴定、诊断预测和预后分层方面具有临床应用价值。冠状动脉微循环功能障碍可能是心力衰竭患者疾病的触发因素，也是潜在的治疗靶点。临床观察性研究表明，内源性腺苷积累对慢性心力衰竭患者的症状、运动能力和左心室功能有显著的有益作用，但这需要在前瞻性随机大规模试验中得到证实。
