Journal
AMERICAN JOURNAL OF MEDICINE
Volume 132, Issue 6, Pages 692-697Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.amjmed.2018.12.038
Keywords
Coronary artery disease; Heart failure; Ischemia; Microvascular dysfunction; Preserved ejection fraction
Categories
Funding
- National Institutes of Health (NIH), National Heart, Lung and Blood Institute [HL087366, HL033610, HL132448, HL130163]
- United States Department of Defense [PR161603]
- Gatorade Trust by the University of Florida Department of Medicine
- NIH NCATS-University of Florida Clinical and Translational Science [UL1TR001427]
- PCORnet-One-Florida Clinical Research Consortium [CDRN-1501-26692]
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Heart failure with preserved ejection fraction (HFpEF) is increasing in prevalence and has no guideline-recommended therapy, related in part to a lack of mechanism. Traditionally, HFpEF was thought to be secondary to afterload overload due to systemic hypertension; however, accumulating evidence suggests that HFpEF continues to worsen despite adequate control of blood pressure. Emerging data support the suggestion that myocardial ischemia secondary to coronary microvascular dysfunction could be the new paradigm pathophysiology. Several prospective, observational cohort studies indicate that the outcomes of patients with microvascular dysfunction, after an interval of several years, are dominated by HFpEF hospitalizations. Further, the most prevalent clinical phenotype (eg older women with multiple comorbidities) of patients with HFpEF resembles those with coronary microvascular dysfunction, albeit older. In this review, we provide in-depth insight about this emerging HFpEF paradigm, discuss potential therapeutic implications of this pathophysiology, and summarize some important knowledge gaps. (C) 2019 Elsevier Inc. All rights reserved.
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