Is Heart Failure A Disorder of the Coronary Microcirculation?

Background: The Heart Failure with Preserved Ejection Fraction (HFpEF) is defined as the preserved left ventricular ejection fraction (LVEF) with the signs of heart failure, elevated natriuretic peptides, and either the evidence of the structural heart disease or diastolic dysfunction. The importance of this form of heart failure was increased after studies where the mortality rates and readmission to the hospital were founded similar as in patients with HF and reduced EF (HFrEF). Coronary microvascular ischemia, cardiomyocyte injury and stiffness could be important factors in the pathophysiology of HFpEF. Methods: The goal of this work is to analyse the relationship of HFpEF and coronary microcirculation in previous studies. Results: The useful diagnostic marker of coronary microcirculation in HFpEF may be the parameters measured by transthoracic echocardiography (TTE), the coronary flow reserve (CFR), as well as fractional flow reserve (FFR) and quantitative myocardial contrast echocardiography (MCE). Cardiac magnetic resonance (CMR) imaging represents the diagnostic gold standard in HFpEF. Coronary microvascular dysfunction in the absence of obstructive coronary artery disease (CAD) is poorly understood and may be more prevalent amongst women than men. Troponin level may be important in risk stratification of HEpEF patients. Conclusion: There are no precise answers with respect to the pathophysiological mechanism, nor are there any precise practical clinical assessment of and diagnostic method for coronary microvascular dysfunction and diastolic dysfunction. In accordance with that, there is no well-established treatment for HFpEF.

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Microcirculation and Heart Failure

Current Pharmaceutical Design ◽

10.2174/1381612824666180625143232 ◽

2018 ◽

Vol 24 (25) ◽

pp. 2954-2959 ◽

Cited By ~ 4

Author(s):

Davor Miličić ◽

Nina Jakuš ◽

Dora Fabijanović

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Coronary Arteries ◽

Coronary Microcirculation ◽

Coronary Microvascular Dysfunction ◽

Reduced Ejection Fraction ◽

Positive Effects ◽

Clinical Scenarios ◽

Wide Range ◽

Peripheral Microcirculation

The idea of coronary microcirculation playing a role in the pathophysiology of heart failure dates from decades ago, with authors hypothesizing that structural and functional alterations in the coronary microcirculation could potentially contribute to heart failure. It is known that in a wide range of primary cardiomyopathies, from dilated to hypertrophic, there are pathological alterations in myocardial vasculature structure and function, playing a role in the clinical course of the disease. Needless to say, many patients with normal epicardial coronary arteries can suffer from coronary microvascular dysfunction, that could lead to a wide variety of clinical problems – from impaired functional capacity to stable and unstable angina, Takotsubo syndrome, myocardial infarction with normal coronary arteries and can also end up with either acute or chronic heart failure. Furthermore, nowadays, it has been recognized that pathophysiology of the heart failure with preserved ejection fraction (HFpEF) is mainly due to the myocardial microcirculatory impairment. In heart failure with reduced ejection fraction (HFrEF) neurohumoral mechanisms affecting the peripheral vasculature have been identified as important factors in the development and progression of heart failure, leading to unfavourable remodelling, and thus some of them being important treatment targets. Among many new clinical scenarios where both myocardial and peripheral microcirculation play an important role, raising field of implantable continuous flow assist devices opens many questions and implies better understanding of their effects of microcirculation, as they usually lead to the improvement of end organ dysfunction caused by previous heart failure, which is probably through the positive effects of peripheral microcirculation.

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Coronary microcirculation and hypertensive heart failure

European Heart Journal ◽

10.1093/eurheartj/ehaa437 ◽

2020 ◽

Vol 41 (25) ◽

pp. 2376-2378 ◽

Cited By ~ 3

Author(s):

Javier Escaned ◽

Lilach O Lerman

Keyword(s):

Heart Failure ◽

Coronary Microcirculation

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High thoracic sympathetic block improves coronary microcirculation disturbance in rats with chronic heart failure

Microvascular Research ◽

10.1016/j.mvr.2018.11.013 ◽

2019 ◽

Vol 122 ◽

pp. 94-100 ◽

Cited By ~ 2

Author(s):

Guifang Sun ◽

Fengqi Liu ◽

Chunhong Xiu

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Coronary Microcirculation ◽

Sympathetic Block ◽

Microcirculation Disturbance

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SPECT Tc 99m sestamibi in the evaluation of carvedilol on coronary microcirculation in the treatment of heart failure (CHF)

Journal of Nuclear Cardiology ◽

10.1016/s1071-3581(99)90474-9 ◽

1999 ◽

Vol 6 (1) ◽

pp. S90

Author(s):

A OREA

Keyword(s):

Heart Failure ◽

Coronary Microcirculation

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Abstract 5502: Adiponectin Mediates the Effects of Atherogenic Risk Profile on the Coronary Microcirculation in Patients with Idiopathic Lv Systolic Dysfunction

Circulation ◽

10.1161/circ.118.suppl_18.s_562-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Daniela Giannessi ◽

Chiara Caselli ◽

Silvia Del Ry ◽

Maristella Maltinti ◽

Manuela Cabiati ◽

...

Keyword(s):

Heart Failure ◽

Plasma Levels ◽

Vascular Function ◽

Systolic Dysfunction ◽

Risk Profile ◽

Coronary Microcirculation ◽

Microvascular Function ◽

Biologically Active ◽

Coronary Microvascular Dysfunction ◽

Coronary Microvascular Function

Purpose. Adiponectin (ADN), a biologically active protein produced by the adipose tissue, has protective vascular effects. Accordingly, ADN plasma levels are reduced in patients with coronary artery disease (CAD) while in heart failure ADN tends to increase. We hypothesized that ADN plasma levels could mediate the effects of atherogenic risk profile on the coronary microcirculation of patients with early LV systolic dysfunction (ILVDys) not secondary to established CAD. Methods. Plasma ADN was measured in 55 patients (age 59±1 yrs, 36 males, BMI 26.9±0.49 Kg/m 2 , mean±sem) with angiographically normal coronary arteries, LV systolic dysfunction (LVEF 39.8±1.3 % range 22–54 %) but without overt heart failure (NYHA class I–II) and in 40 age- and BMI-matched healthy controls by using a specific Elisa (Linco Res). BMI, cholesterol and glucose profiles were assessed in all. In a subset of 25 patients coronary microvascular function was studied by PET and 13 N-Ammonia as a flow tracer. Myocardial blood flow (MBF) was measured at rest and during i.v. dipyridamole (Dip) (0.56 mg/Kg in 4 min). Results. ADN was 6.6±0.34 μg/ml in controls and 10.9±0.85 in ILVDys patients (p<0.001). In patients ADN levels were inversely related with BMI (p=0.009) and directly related with age (p=0.007), HDL Cholesterol (p=0.003) and MBF Dip (0.020). Patients showing more severe coronary microvascular dysfunction (MBF Dip<1.42 ml/min/g, median value in patients) had significantly depressed ADN (9.7±2.3 vs 13.7±1.6, p=0.021) as compared with the remaining patients. Conclusions. This is the first study which associates adiponectin plasma levels with atherogenic risk profile and coronary microvascular function in patients with idiopathic LV dysfunction. These results suggest that adiponectin signal is strongly involved in mediating coronary vascular function independently of the presence of overt CAD or heart failure.

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