Coronary microvascular disease (CMD), characterized by impaired coronary flow reserve (CFR), is a common finding in patients with stable angina. Impaired CFR, in the absence of obstructive coronary artery disease, is also present in up to 75% of patients with heart failure with preserved ejection fraction (HFpEF). Heart failure with preserved ejection fraction is a heterogeneous syndrome comprising distinct endotypes and it has been hypothesized that CMD lies at the centre of the pathogenesis of one such entity: the CMD–HFpEF endotype. This article provides a contemporary review of the pathophysiology underlying CMD, with a focus on the mechanistic link between CMD and HFpEF. We discuss the central role played by subendocardial ischaemia and impaired lusitropy in the development of CMD–HFpEF, as well as the clinical and research implications of the CMD–HFpEF mechanistic link. Future prospective follow-up studies detailing outcomes in patients with CMD and HFpEF are much needed to enhance our understanding of the pathological processes driving these conditions, which may lead to the development of physiology-stratified therapy to improve the quality of life and prognosis in these patients.

中文翻译：

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在保留射血分数的情况下解开冠状动脉微血管功能障碍和心力衰竭之间的病理生理联系

冠状动脉微血管疾病 (CMD) 以冠状动脉血流储备 (CFR) 受损为特征，是稳定型心绞痛患者的常见发现。在没有阻塞性冠状动脉疾病的情况下，高达 75% 的射血分数保留的心力衰竭 (HFpEF) 患者也存在 CFR 受损。射血分数保留的心力衰竭是一种异质综合征，包括不同的内型，据推测 CMD 位于一个此类实体的发病机制的中心：CMD-HFpEF 内型。本文对 CMD 的病理生理学进行了当代回顾，重点关注 CMD 和 HFpEF 之间的机制联系。我们讨论了心内膜下缺血和肠胃功能受损在 CMD-HFpEF 发展中的核心作用，以及 CMD-HFpEF 机制链接的临床和研究意义。未来的前瞻性随访研究非常需要详细说明 CMD 和 HFpEF 患者的结果，以增强我们对驱动这些疾病的病理过程的理解，这可能会导致生理分层疗法的发展，以改善这些患者的生活质量和预后。患者。