Dimitriadis Kyriakos, Theofilis Panagiotis, Koutsopoulos Georgios, Pyrpyris Nikolaos, Beneki Eirini, Tatakis Fotis, Tsioufis Panagiotis, Chrysohoou Christina, Fragkoulis Christos, Tsioufis Konstantinos
First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Vasilissis Sofias 114, 11528, Athens, PO, Greece.
Heart Fail Rev. 2025 Jan;30(1):75-88. doi: 10.1007/s10741-024-10445-3. Epub 2024 Oct 3.
Heart failure with preserved ejection fraction (HFpEF) represents an entity with complex pathophysiologic pathways, among which coronary microvascular dysfunction (CMD) is believed to be an important orchestrator. Research in the field of CMD has highlighted impaired vasoreactivity, capillary rarefaction, and inflammation as potential mediators of its development. CMD can be diagnosed via several noninvasive methods including transthoracic echocardiography, cardiac magnetic resonance, and positron emission tomography. Moreover, invasive methods such as coronary flow reserve and index of microcirculatory resistance are commonly employed in the assessment of CMD. As far as the association between CMD and HFpEF is concerned, numerous studies have highlighted the coexistence of CMD in the majority of HFpEF patients. Additionally, patients affected by both conditions may be facing an adverse prognosis. Finally, there is limited evidence suggesting a beneficial effect of renin-angiotensin-aldosterone system blockers, ranolazine, and sodium-glucose cotransporter-2 inhibitors in CMD, with further evidence being awaited regarding the impact of other pharmacotherapies such as anti-inflammatory agents.
射血分数保留的心力衰竭（HFpEF）是一种具有复杂病理生理途径的疾病，其中冠状动脉微血管功能障碍（CMD）被认为是一个重要的调控因素。CMD领域的研究强调血管反应性受损、毛细血管稀疏和炎症是其发展的潜在介导因素。CMD可通过多种非侵入性方法进行诊断，包括经胸超声心动图、心脏磁共振成像和正电子发射断层扫描。此外，冠状动脉血流储备和微循环阻力指数等侵入性方法常用于CMD的评估。就CMD与HFpEF之间的关联而言，大量研究强调了大多数HFpEF患者中CMD的共存。此外，同时患有这两种疾病的患者可能面临不良预后。最后，仅有有限的证据表明肾素-血管紧张素-醛固酮系统阻滞剂、雷诺嗪和钠-葡萄糖协同转运蛋白2抑制剂对CMD有有益作用，关于其他药物治疗（如抗炎药）的影响还有待进一步的证据。
