Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
Division of Cardiology, AOU Maggiore della Carità, Novara, Italy.
ESC Heart Fail. 2024 Aug;11(4):2063-2075. doi: 10.1002/ehf2.14626. Epub 2024 Mar 28.
Several mechanisms have been identified in the aetiopathogenesis of heart failure with preserved ejection fraction (HFpEF). Among these, coronary microvascular dysfunction (CMD) may play a key pathophysiological role. We performed a systematic review and meta-analysis to investigate the prevalence, echocardiographic correlates, and prognostic implications of CMD in patients with HFpEF.
A systematic search for articles up to 1 May 2023 was performed. The primary aim was to assess the prevalence of CMD. Secondary aims were to compare key echocardiographic parameters (E/e' ratio, left atrial volume index [LAVi], and left ventricular mass index [LVMi]), clinical outcomes [death and hospitalization for heart failure (HF)], and prevalence of atrial fibrillation (AF) between patients with and without CMD. Meta-regressions according to baseline patient characteristics and study features were performed to explore potential heterogeneity sources. We identified 14 observational studies, enrolling 1138 patients with HFpEF. The overall prevalence of CMD was 58%. Compared with patients without CMD, patients with HFpEF and CMD had larger LAVi [mean difference (MD) 3.85 confidence interval (CI) 1.19-6.5, P < 0.01)], higher E/e' ratio (MD 2.76 CI 1.54-3.97; P < 0.01), higher prevalence of AF (odds ratio 1.61 CI 1.04-2.48, P = 0.03) and higher risk of death or hospitalization for HF [hazard ratio 3.19, CI 1.04-9.57, P = 0.04].
CMD is present in little more than half of the patients with HFpEF and is associated with echocardiographic evidence of more severe diastolic dysfunction and a higher prevalence of AF, doubling the risk of death or HF hospitalization.
已确定射血分数保留型心力衰竭（HFpEF）发病机制中的几种机制。其中，冠状动脉微血管功能障碍（CMD）可能起着关键的病理生理作用。我们进行了系统评价和荟萃分析，以研究 CMD 在 HFpEF 患者中的患病率、超声心动图相关性和预后意义。
对截至 2023 年 5 月 1 日的文章进行了系统检索。主要目的是评估 CMD 的患病率。次要目的是比较关键的超声心动图参数（E/e'比值、左心房容积指数[LAVi]和左心室质量指数[LVMi]）、临床结局（死亡和心力衰竭[HF]住院）以及CMD 患者与无 CMD 患者之间的心房颤动（AF）患病率。根据基线患者特征和研究特征进行了荟萃回归分析，以探索潜在的异质性来源。我们确定了 14 项观察性研究，共纳入 1138 例 HFpEF 患者。CMD 的总体患病率为 58%。与无 CMD 的患者相比，HFpEF 合并 CMD 的患者的 LAVi 更大[平均差值（MD）3.85 置信区间（CI）1.19-6.5，P<0.01]，E/e'比值更高（MD 2.76 CI 1.54-3.97；P<0.01），AF 发生率更高（优势比 1.61 CI 1.04-2.48，P=0.03），HF 死亡或住院风险更高[风险比 3.19，CI 1.04-9.57，P=0.04]。
CMD 在 HFpEF 患者中存在略多于一半，与更严重的舒张功能障碍的超声心动图证据相关，并且 AF 发生率更高，HF 死亡或住院风险增加一倍。
