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Review
. 2022 Jul 1:8:e24.
doi: 10.15420/cfr.2022.12. eCollection 2022 Jan.

Microvascular Dysfunction in Heart Failure with Preserved Ejection Fraction: Pathophysiology, Assessment, Prevalence and Prognosis

Joanna M Bilak  1 , Uazman Alam  2   3   4 , Christopher A Miller  5 , Gerry P McCann  1 , Jayanth R Arnold  1 , Prathap Kanagala  2   6
Affiliations
Review

Microvascular Dysfunction in Heart Failure with Preserved Ejection Fraction: Pathophysiology, Assessment, Prevalence and Prognosis

Joanna M Bilak et al. Card Fail Rev. .

Abstract

Heart failure with preserved ejection fraction (HFpEF) currently accounts for approximately half of all new heart failure cases in the community. HFpEF is closely associated with chronic lifestyle-related diseases, such as obesity and type 2 diabetes, and clinical outcomes are worse in those with than without comorbidities. HFpEF is pathophysiologically distinct from heart failure with reduced ejection fraction, which may explain, in part, the disparity of treatment options available between the two heart failure phenotypes. The mechanisms underlying HFpEF are complex, with coronary microvascular dysfunction (MVD) being proposed as a potential key driver in its pathophysiology. In this review, the authors highlight the evidence implicating MVD in HFpEF pathophysiology, the diagnostic approaches for identifying MVD (both invasive and non-invasive) and the prevalence and prognostic significance of MVD.

Keywords: Heart failure with preserved ejection fraction; cardiovascular MRI; diagnosis; fibrosis; microvascular dysfunction; prevalence; prognosis.

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Conflict of interest statement

Disclosure: CAM has served on advisory boards for Novartis, Boehringer Ingelheim and Lilly Alliance, and AstraZeneca, serves as an advisor for HAYA Therapeutics and PureTech Health and has received research support from Amicus Therapeutics, Guerbet Laboratories Limited, Roche and Univar Solutions. PK has received honoraria for presentations from Novartis and NovoNordisk, and is on the Cardiac Failure Review editorial board; this did not influence peer review. All other authors have no conflicts of interest to declare.

Figures

Figure 1:
Figure 1:. Proposed Pathophysiological Mechanisms Behind Heart Failure with Preserved Ejection Fraction, Including Contributions From Microvascular Dysfunction and Fibrosis
See this image and copyright information in PMC

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