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Comment
. 2018 Mar 7;39(10):850-852.
doi: 10.1093/eurheartj/ehx818.

Coronary microvascular dysfunction and heart failure with preserved ejection fraction as female-pattern cardiovascular disease: the chicken or the egg?

Michael D Nelson  1 , Janet Wei  2 , C Noel Bairey Merz  2
Affiliations
Comment

Coronary microvascular dysfunction and heart failure with preserved ejection fraction as female-pattern cardiovascular disease: the chicken or the egg?

Michael D Nelson et al. Eur Heart J. .
No abstract available

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Is coronary microvascular dysfunction (CMD) causal for ventricular remodelling and diastolic dysfunction and/or are ventricular remodelling and diastolic dysfunction causal for CMD? Emerging evidence suggest that a progressive clustering of risk factors (hypertension, dyslipidaemia, dysglycaemia, and oestrogen loss) promote a pro-inflammatory and pro-oxidative state, rendering the coronary microvasculature vulnerable to repeat epidsodes of myocardial ischaemia. These repeat episodes of ischaemic insult lead to progressive impairment of energy-dependent cardiomyocyte relaxation and a shift in substrate metabolism, leading to cardiac steatosis, left ventricular diastolic dysfunction, and ultimately the development of heart failure. Several knowledge gaps exist, however, including therapies to treat metabolic and inflammatory pathways, and prevent myocellular damage. Moreover, it remains unclear to what extent adverse remodelling and diastolic dysfunction contribute to CMD. Future work focusing on these important questions is desperately needed to fill key knowledge gaps (indicated by ‘?’).
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