Bilak Joanna M, Alam Uazman, Miller Christopher A, McCann Gerry P, Arnold Jayanth R, Kanagala Prathap
Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital Leicester, UK.
Liverpool University Hospitals NHS Foundation Trust Liverpool, UK.
Card Fail Rev. 2022 Jul 1;8:e24. doi: 10.15420/cfr.2022.12. eCollection 2022 Jan.
Heart failure with preserved ejection fraction (HFpEF) currently accounts for approximately half of all new heart failure cases in the community. HFpEF is closely associated with chronic lifestyle-related diseases, such as obesity and type 2 diabetes, and clinical outcomes are worse in those with than without comorbidities. HFpEF is pathophysiologically distinct from heart failure with reduced ejection fraction, which may explain, in part, the disparity of treatment options available between the two heart failure phenotypes. The mechanisms underlying HFpEF are complex, with coronary microvascular dysfunction (MVD) being proposed as a potential key driver in its pathophysiology. In this review, the authors highlight the evidence implicating MVD in HFpEF pathophysiology, the diagnostic approaches for identifying MVD (both invasive and non-invasive) and the prevalence and prognostic significance of MVD.
射血分数保留的心力衰竭（HFpEF）目前约占社区所有新发心力衰竭病例的一半。HFpEF与慢性生活方式相关疾病密切相关，如肥胖和2型糖尿病，合并症患者的临床结局比无合并症患者更差。HFpEF在病理生理上与射血分数降低的心力衰竭不同，这在一定程度上可以解释两种心力衰竭表型之间可用治疗方案的差异。HFpEF的潜在机制很复杂，冠状动脉微血管功能障碍（MVD）被认为是其病理生理学中的一个潜在关键驱动因素。在这篇综述中，作者强调了MVD在HFpEF病理生理学中的证据、识别MVD的诊断方法（包括有创和无创）以及MVD的患病率和预后意义。
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