Coronary Artery Disease in Heart Failure With Preserved Ejection Fraction

IF 2.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology Pub Date : 2025-08-25 DOI:10.1016/j.amjcard.2025.08.035

Ryohei Ono MD, PhD , Luiz Menezes Falcão MD, PhD

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引用次数: 0

Abstract

Coronary artery disease (CAD), including both obstructive epicardial coronary artery disease and coronary microvascular dysfunction (CMD), is a common and impactful contributor to heart failure with preserved ejection fraction (HFpEF). CAD is associated with worse outcomes, progressive myocardial remodeling, and transition to reduced ejection fraction. CMD, which is particularly prevalent in women, impairs myocardial perfusion and energetics. This leads to exercise intolerance and elevated filling pressures. Emerging treatments such as sodium-glucose co-transporter 2 (SGLT2) inhibitors and finerenone offer benefit across HFpEF phenotypes, including those with ischemia. Multimodal diagnostic approaches, such as positron emission tomography, cardiovascular magnetic resonance, Doppler echocardiography, and invasive coronary physiology, are essential to identify CMD and subclinical CAD in appropriate patients. In conclusion, recognizing ischemic phenotypes within HFpEF is critical for risk stratification and therapeutic decision-making. Future studies should focus on phenotype-specific strategies to improve outcomes in this heterogeneous syndrome.

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保留射血分数的心力衰竭患者冠状动脉疾病。

冠状动脉疾病（CAD），包括阻塞性心外膜冠状动脉疾病和冠状动脉微血管功能障碍（CMD），是具有保留射血分数（HFpEF）的心力衰竭的常见和影响因素。冠心病与较差的预后、进行性心肌重构和过渡到射血分数降低有关。CMD在女性中尤为普遍，它会损害心肌灌注和能量。这会导致运动不耐受和充盈压力升高。新兴的治疗方法，如钠-葡萄糖共转运蛋白2 （SGLT2）抑制剂和细芬烯酮，对包括缺血在内的HFpEF表型都有益处。多模式诊断方法，如正电子发射断层扫描、心血管磁共振、多普勒超声心动图和侵入性冠状动脉生理学，对于在适当的患者中识别CMD和亚临床CAD至关重要。总之，在HFpEF中识别缺血表型对于风险分层和治疗决策至关重要。未来的研究应侧重于表型特异性策略，以改善这种异质性综合征的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Cardiology 医学-心血管系统

CiteScore

4.00

自引率

3.60%

发文量

698

审稿时长

33 days

期刊介绍： Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.