Al-Khayatt Becker, Perera Divaka, Rahman Haseeb
The British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom.
Am Heart J Plus. 2024 Mar 22;41:100387. doi: 10.1016/j.ahjo.2024.100387. eCollection 2024 May.
Heart failure with preserved ejection fraction (HFpEF) is a common condition with few effective therapies and hence represents a major healthcare burden. The clinical syndrome of HFpEF can be caused by varying pathophysiological processes, with coronary microvascular dysfunction (CMD) proposed as one of the aetiologies, although confirming causality has been challenging. CMD is characterised by the inability of the coronary vasculature to augment blood flow in response to a physiological stressor and has been established as the driver of angina in patients with non-obstructed coronaries (ANOCA), and this has subsequently led to efficacious endotype-directed therapies. CMD is also highly prevalent among sufferers of HFpEF and may represent a novel treatment target for this particular endotype of this condition. This review aims to discuss the role of the microcirculation in the healthy heart how it's dysfunction may precipitate HFpEF and explore the current diagnostic tools available. We also discuss the gaps in evidence and where we believe future research should be focussed.
射血分数保留的心力衰竭（HFpEF）是一种常见疾病，有效治疗方法很少，因此是一项重大的医疗负担。HFpEF的临床综合征可能由多种病理生理过程引起，冠状动脉微血管功能障碍（CMD）被认为是病因之一，尽管证实因果关系具有挑战性。CMD的特征是冠状动脉血管系统无法响应生理应激源而增加血流量，并且已被确认为非阻塞性冠状动脉（ANOCA）患者心绞痛的驱动因素，随后这导致了有效的内型导向治疗。CMD在HFpEF患者中也非常普遍，可能是这种特定疾病内型的新治疗靶点。本综述旨在讨论微循环在健康心脏中的作用、其功能障碍如何引发HFpEF，并探索现有的诊断工具。我们还将讨论证据空白以及我们认为未来研究应关注的方向。
