Singh Ajeet, Ashraf Saad, Irfan Hamza, Venjhraj Fnu, Verma Amogh, Shaukat Ayesha, Tariq Muhammad Daoud, Hamza Hafiz Muhammad
Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Ann Med Surg (Lond). 2024 Dec 24;87(2):616-626. doi: 10.1097/MS9.0000000000002971. eCollection 2025 Feb.
Microvascular dysfunction (MVD) is increasingly recognized as a critical contributor to the pathogenesis of heart failure (HF), particularly in heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). Coronary microvascular dysfunction (CMD) significantly impacts HFpEF by reducing coronary flow reserve and myocardial perfusion reserve, leading to adverse outcomes such as myocardial ischemia, diastolic dysfunction, and increased risk of major cardiovascular events, including atrial fibrillation. In HFrEF, microvascular impairment is linked to heightened oxidative stress, reduced nitric oxide production, and activation of the renin-angiotensin-aldosterone system, further driving disease progression and contributing to poor prognosis. Advancements in diagnostic techniques, such as positron emission tomography, cardiac magnetic resonance imaging, and biomarker analysis, improve our ability to assess CMD in heart failure patients, enabling earlier diagnosis and risk stratification. Emerging therapies, including sodium-glucose cotransporter-2 inhibitors, angiotensin receptor-neprilysin inhibitors, and endothelial-targeted interventions, enhance microvascular function and improve patient outcomes. The role of personalized medicine is becoming increasingly important, as individualized therapeutic approaches tailored to patient-specific microvascular abnormalities are essential for optimizing treatment effectiveness. This review underscores the pivotal role of MVD in HF. It highlights the urgent need for innovative therapeutic strategies and diagnostic tools to address this complex condition and improve clinical outcomes for HF patients.
微血管功能障碍（MVD）日益被认为是心力衰竭（HF）发病机制的关键促成因素，尤其是在射血分数保留的心力衰竭（HFpEF）和射血分数降低的心力衰竭（HFrEF）中。冠状动脉微血管功能障碍（CMD）通过降低冠状动脉血流储备和心肌灌注储备，对HFpEF产生显著影响，导致诸如心肌缺血、舒张功能障碍以及包括房颤在内的重大心血管事件风险增加等不良后果。在HFrEF中，微血管损伤与氧化应激增强、一氧化氮生成减少以及肾素 - 血管紧张素 - 醛固酮系统激活有关，进一步推动疾病进展并导致预后不良。正电子发射断层扫描、心脏磁共振成像和生物标志物分析等诊断技术的进步，提高了我们评估心力衰竭患者CMD的能力，有助于早期诊断和风险分层。包括钠 - 葡萄糖协同转运蛋白2抑制剂、血管紧张素受体 - 脑啡肽酶抑制剂和内皮靶向干预措施在内的新兴疗法，可增强微血管功能并改善患者预后。个性化医疗的作用变得越来越重要，因为针对患者特定微血管异常的个体化治疗方法对于优化治疗效果至关重要。本综述强调了MVD在HF中的关键作用。它突出了迫切需要创新的治疗策略和诊断工具来应对这一复杂病症并改善HF患者的临床结局。
