The role of coronary microcirculation in heart failure with preserved ejection fraction: An unceasing odyssey.

IF 4.5 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Kyriakos Dimitriadis, Panagiotis Theofilis, Georgios Koutsopoulos, Nikolaos Pyrpyris, Eirini Beneki, Fotis Tatakis, Panagiotis Tsioufis, Christina Chrysohoou, Christos Fragkoulis, Konstantinos Tsioufis
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引用次数: 0

Abstract

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.

冠状动脉微循环在射血分数保留型心力衰竭中的作用:永无止境的奥德赛
射血分数保留型心力衰竭(HFpEF)具有复杂的病理生理途径,其中冠状动脉微血管功能障碍(CMD)被认为是一个重要的协调因素。CMD领域的研究强调,血管活性受损、毛细血管稀疏和炎症是其发展的潜在介质。CMD 可通过几种非侵入性方法诊断,包括经胸超声心动图、心脏磁共振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有创方法也常用于评估 CMD。就 CMD 与高频血流衰竭之间的关联而言,许多研究都强调大多数高频血流衰竭患者同时患有 CMD。此外,同时患有这两种疾病的患者可能会面临不良预后。最后,有限的证据表明,肾素-血管紧张素-醛固酮系统阻断剂、雷诺拉嗪和钠-葡萄糖共转运体-2 抑制剂对 CMD 有益,至于其他药物疗法(如抗炎药物)的影响,还有待于进一步的证据。
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来源期刊
Heart Failure Reviews
Heart Failure Reviews 医学-心血管系统
CiteScore
10.40
自引率
2.20%
发文量
90
审稿时长
6-12 weeks
期刊介绍: Heart Failure Reviews is an international journal which develops links between basic scientists and clinical investigators, creating a unique, interdisciplinary dialogue focused on heart failure, its pathogenesis and treatment. The journal accordingly publishes papers in both basic and clinical research fields. Topics covered include clinical and surgical approaches to therapy, basic pharmacology, biochemistry, molecular biology, pathology, and electrophysiology. The reviews are comprehensive, expanding the reader''s knowledge base and awareness of current research and new findings in this rapidly growing field of cardiovascular medicine. All reviews are thoroughly peer-reviewed before publication.
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