Heart Failure With Preserved Ejection Fraction: Is Ischemia Due to Coronary Microvascular Dysfunction a Mechanistic Factor?

Islam Y. Elgendy; Carl J. Pepine

doi:10.1016/j.amjmed.2018.12.038

Heart Failure With Preserved Ejection Fraction: Is Ischemia Due to Coronary Microvascular Dysfunction a Mechanistic Factor?

Islam Y. Elgendy, Carl J. Pepine

Research output: Contribution to journal › Review article › peer-review

50 Scopus citations

Abstract

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.

Original language	English
Pages (from-to)	692-697
Number of pages	6
Journal	American Journal of Medicine
Volume	132
Issue number	6
DOIs	https://doi.org/10.1016/j.amjmed.2018.12.038
State	Published - Jun 2019

Bibliographical note

Publisher Copyright:
© 2019 Elsevier Inc.

Funding

Funding: CJP receives support from the National Institutes of Health (NIH), National Heart, Lung and Blood Institute HL087366; HL033610, HL132448, HL130163; the United States Department of Defense PR161603; the Gatorade Trust through funds distributed by the University of Florida Department of Medicine; NIH NCATS—University of Florida Clinical and Translational Science UL1TR001427; and PCORnet-OneFlorida Clinical Research Consortium CDRN-1501-26692.

Funders	Funder number
Gatorade Trust
PCORnet-OneFlorida Clinical Research Consortium	CDRN-1501-26692
University of Florida Department of Medicine
National Institutes of Health (NIH)
U.S. Department of Defense	PR161603
National Heart, Lung, and Blood Institute (NHLBI)	HL130163, HL087366, HL132448
National Center for Advancing Translational Sciences (NCATS)	UL1TR001427
Clinical and Translational Science Institute, University of Florida

Keywords

Coronary artery disease
Heart failure
Ischemia
Microvascular dysfunction
Preserved ejection fraction

ASJC Scopus subject areas

General Medicine

Access to Document

10.1016/j.amjmed.2018.12.038

Cite this

@article{e3e5f8b9aa80423892d0554609514bab,

title = "Heart Failure With Preserved Ejection Fraction: Is Ischemia Due to Coronary Microvascular Dysfunction a Mechanistic Factor?",

abstract = "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.",

keywords = "Coronary artery disease, Heart failure, Ischemia, Microvascular dysfunction, Preserved ejection fraction",

author = "Elgendy, \{Islam Y.\} and Pepine, \{Carl J.\}",

note = "Publisher Copyright: {\textcopyright} 2019 Elsevier Inc.",

year = "2019",

month = jun,

doi = "10.1016/j.amjmed.2018.12.038",

language = "English",

volume = "132",

pages = "692--697",

number = "6",

}

TY - JOUR

T1 - Heart Failure With Preserved Ejection Fraction

T2 - Is Ischemia Due to Coronary Microvascular Dysfunction a Mechanistic Factor?

AU - Elgendy, Islam Y.

AU - Pepine, Carl J.

PY - 2019/6

Y1 - 2019/6

N2 - 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.

AB - 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.

KW - Coronary artery disease

KW - Heart failure

KW - Ischemia

KW - Microvascular dysfunction

KW - Preserved ejection fraction

UR - https://www.scopus.com/pages/publications/85062015771

UR - https://www.scopus.com/inward/citedby.url?scp=85062015771&partnerID=8YFLogxK

U2 - 10.1016/j.amjmed.2018.12.038

DO - 10.1016/j.amjmed.2018.12.038

M3 - Review article

C2 - 30684452

AN - SCOPUS:85062015771

SN - 0002-9343

VL - 132

SP - 692

EP - 697

JO - American Journal of Medicine

JF - American Journal of Medicine

IS - 6

ER -

Heart Failure With Preserved Ejection Fraction: Is Ischemia Due to Coronary Microvascular Dysfunction a Mechanistic Factor?

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this