University of Belgrade, Faculty of Medicine, Belgrade, Serbia.
Clinic of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia.
Curr Pharm Des. 2018;24(25):2960-2966. doi: 10.2174/1381612824666180711124131.
The Heart Failure with Preserved Ejection Fraction (HFpEF) is defined as the preserved left ventricular ejection fraction (LVEF) with the signs of heart failure, elevated natriuretic peptides, and either the evidence of the structural heart disease or diastolic dysfunction. The importance of this form of heart failure was increased after studies where the mortality rates and readmission to the hospital were founded similar as in patients with HF and reduced EF (HFrEF). Coronary microvascular ischemia, cardiomyocyte injury and stiffness could be important factors in the pathophysiology of HFpEF.
The goal of this work is to analyse the relationship of HFpEF and coronary microcirculation in previous studies.
The useful diagnostic marker of coronary microcirculation in HFpEF may be the parameters measured by transthoracic echocardiography (TTE), the coronary flow reserve (CFR), as well as fractional flow reserve (FFR) and quantitative myocardial contrast echocardiography (MCE). Cardiac magnetic resonance (CMR) imaging represents the diagnostic gold standard in HFpEF. Coronary microvascular dysfunction in the absence of obstructive coronary artery disease (CAD) is poorly understood and may be more prevalent amongst women than men. Troponin level may be important in risk stratification of HEpEF patients.
There are no precise answers with respect to the pathophysiological mechanism, nor are there any precise practical clinical assessment of and diagnostic method for coronary microvascular dysfunction and diastolic dysfunction. In accordance with that, there is no well-established treatment for HFpEF.
射血分数保留的心力衰竭（HFpEF）的定义为左心室射血分数（LVEF）保留伴有心力衰竭的迹象、升高的利钠肽和结构性心脏病或舒张功能障碍的证据。在研究中发现，HFpEF 患者的死亡率和再入院率与射血分数降低的心力衰竭（HFrEF）患者相似，这种形式的心力衰竭的重要性增加了。冠状动脉微血管缺血、心肌细胞损伤和僵硬可能是 HFpEF 病理生理学中的重要因素。
本研究的目的是分析以前的研究中 HFpEF 与冠状动脉微循环的关系。
HFpEF 中冠状动脉微循环的有用诊断标志物可能是经胸超声心动图（TTE）测量的参数，即冠状动脉血流储备（CFR），以及分数流量储备（FFR）和定量心肌对比超声心动图（MCE）。心脏磁共振（CMR）成像代表 HFpEF 的诊断金标准。在不存在阻塞性冠状动脉疾病（CAD）的情况下，冠状动脉微血管功能障碍理解较差，且可能在女性中比男性中更为普遍。肌钙蛋白水平可能对 HEpEF 患者的风险分层很重要。
对于病理生理机制，没有确切的答案，也没有针对冠状动脉微血管功能障碍和舒张功能障碍的精确实用的临床评估和诊断方法。因此，HFpEF 尚无既定的治疗方法。
