期刊
CIRCULATION RESEARCH
卷 124, 期 11, 页码 1520-1535出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCRESAHA.118.313568
关键词
coronary artery disease; heart failure; hospitalization; inflammation; myocardial ischemia
资金
- National Institutes of Health (NIH) [HL087366, HL132448, HL033610, HL130163]
- US Department of Defense [PR161603]
- Gatorade Trust through University of Florida Department of Medicine
- NIH NCATS (National Center for Advancing Translational Sciences)-University of Florida Clinical and Translational Science [UL1TR001427]
- PCORnet-OneFlorida Clinical Research Consortium [CDRN-1501-26692]
Patients with heart failure (HF) syndromes have been categorized as those with reduced ejection fraction (EF) or preserved EF (HFpEF), and ischemia plays a key role in both types. HF remains a major cause of morbidity and mortality worldwide, and with the aging of our population this burden continues to rise, predominantly as a result of hospitalizations for HFpEF. Patients with obstructive coronary artery disease more likely have HF with reduced EF, rather than HFpEF, secondary to acute ischemic injury resulting in myocardial infarction, and large outcomes trials of treatments with neurohumoral inhibition have documented reduced adverse outcomes. In contrast, similar treatments in patients with HFpEF have not proven beneficial. This therapeutic dilemma may be attributed, in part, to heterogeneity in the underlying pathophysiology with different systemic and myocardial signaling pathways, despite similar clinical presentations and findings, in patients with HFpEF. Also, emerging evidence indicates that impaired myocardial perfusion and inflammation secondary to multiple comorbidities are key mechanisms in HFpEF. We will thoroughly review the role of ischemic heart disease in the pathogenesis of HF with reduced EF and HFpEF, and discuss the medical management strategies available for these conditions.
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