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

Joanna M Bilak; Uazman Alam; Christopher A Miller; Gerry P McCann; Jayanth R Arnold; Prathap Kanagala

doi:10.15420/cfr.2022.12

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

Card Fail Rev. 2022 Jul 1:8:e24. doi: 10.15420/cfr.2022.12. eCollection 2022 Jan.

Authors

Joanna M Bilak¹, Uazman Alam^{2

3

4}, Christopher A Miller⁵, Gerry P McCann¹, Jayanth R Arnold¹, Prathap Kanagala^{2

6}

Affiliations

¹ Department of Cardiovascular Sciences, University of Leicester and the Leicester NIHR Biomedical Research Centre, Glenfield Hospital Leicester, UK.
² Liverpool University Hospitals NHS Foundation Trust Liverpool, UK.
³ Division of Diabetes, Endocrinology and Gastroenterology, Institute of Human Development, University of Manchester Manchester, UK.
⁴ Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool Liverpool, UK.
⁵ Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre Manchester, UK.
⁶ Liverpool Centre for Cardiovascular Sciences, Faculty of Health and Life Sciences Liverpool, UK.

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.

Publication types

Review

Abstract

Publication types

Grants and funding