Cardio Center, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy.
Heart Fail Rev. 2020 Jan;25(1):53-65. doi: 10.1007/s10741-019-09831-z.
Heart failure is a complex clinical syndrome and represents the final path of numerous heart diseases. Coronary artery disease is recognized as the primary risk factor for heart failure development, being the main etiological factor in more than 50% of heart failure patients in North America and Europe. Regardless of overt coronary artery disease, myocardial ischemia is a common finding in failing hearts, likely due to structural or functional coronary circulation alterations. Ischemia is a self-propagating process which irreversibly impairs the cardiac function and negatively impacts prognosis. Thus, a better and thorough understanding of myocardial ischemia pathophysiology in heart failure would likely lead to significantly improved outcomes in these patients. This review aims to describe the mechanisms of myocardial ischemia and coronary artery disease in heart failure, focusing on coronary circulation dysfunctions due to increased parietal stress or non-obstructive coronary disease, and discussing the association and management of coronary artery disease in patients with heart failure.
心力衰竭是一种复杂的临床综合征，代表了许多心脏病的最终发展路径。冠状动脉疾病被认为是心力衰竭发展的主要危险因素，在北美和欧洲超过 50%的心力衰竭患者中，它是主要的病因。无论是否存在明显的冠状动脉疾病，心肌缺血都是衰竭心脏的常见表现，可能是由于结构性或功能性冠状动脉循环改变所致。缺血是一种自我传播的过程，它会不可逆地损害心脏功能，对预后产生负面影响。因此，更好地、更全面地了解心力衰竭中心肌缺血的病理生理学，可能会显著改善这些患者的结局。本篇综述旨在描述心力衰竭中心肌缺血和冠状动脉疾病的机制，重点讨论由于壁面应力增加或非阻塞性冠状动脉疾病引起的冠状动脉循环功能障碍，并讨论心力衰竭患者的冠状动脉疾病的相关性和管理。
