Basic Research in Cardiology ( IF 9.5 ) Pub Date : 2022-01-13 , DOI: 10.1007/s00395-022-00909-8 Gerd Heusch 1
Heart failure is a clinical syndrome where cardiac output is not sufficient to sustain adequate perfusion and normal bodily functions, initially during exercise and in more severe forms also at rest. The two most frequent forms are heart failure of ischemic origin and of non-ischemic origin. In heart failure of ischemic origin, reduced coronary blood flow is causal to cardiac contractile dysfunction, and this is true for stunned and hibernating myocardium, coronary microembolization, myocardial infarction and post-infarct remodeling, possibly also for the takotsubo syndrome. The most frequent form of non-ischemic heart failure is dilated cardiomyopathy, caused by genetic mutations, myocarditis, toxic agents or sustained tachyarrhythmias, where alterations in coronary blood flow result from and contribute to cardiac contractile dysfunction. Hypertrophic cardiomyopathy is caused by genetic mutations but can also result from increased pressure and volume overload (hypertension, valve disease). Heart failure with preserved ejection fraction is characterized by pronounced coronary microvascular dysfunction, the causal contribution of which is however not clear. The present review characterizes the alterations of coronary blood flow which are causes or consequences of heart failure in its different manifestations. Apart from any potentially accompanying coronary atherosclerosis, all heart failure entities share common features of impaired coronary blood flow, but to a different extent: enhanced extravascular compression, impaired nitric oxide-mediated, endothelium-dependent vasodilation and enhanced vasoconstriction to mediators of neurohumoral activation. Impaired coronary blood flow contributes to the progression of heart failure and is thus a valid target for established and novel treatment regimens.
中文翻译:
心力衰竭的冠状动脉血流:原因、后果和旁观者
心力衰竭是一种临床综合征,其中心输出量不足以维持足够的灌注和正常的身体功能,最初是在运动期间,更严重的形式是在休息时。两种最常见的形式是缺血性心力衰竭和非缺血性心力衰竭。在缺血性心力衰竭中,冠状动脉血流量减少是心脏收缩功能障碍的原因,对于休眠和冬眠心肌、冠状动脉微栓塞、心肌梗塞和梗塞后重构,可能也适用于 takotsubo 综合征。最常见的非缺血性心力衰竭形式是扩张型心肌病,由基因突变、心肌炎、有毒物质或持续的快速性心律失常引起,其中冠状动脉血流的改变是由心脏收缩功能障碍引起并促成的。肥厚型心肌病由基因突变引起,但也可能由压力增加和容量超负荷(高血压、瓣膜疾病)引起。射血分数保留的心力衰竭的特征是明显的冠状动脉微血管功能障碍,但其因果关系尚不清楚。本综述描述了冠状动脉血流改变的特征,这些改变是心力衰竭不同表现的原因或后果。除了任何可能伴随的冠状动脉粥样硬化外,所有心力衰竭实体都具有冠状动脉血流受损的共同特征,但程度不同:增强的血管外压缩,受损的一氧化氮介导的内皮依赖性血管舒张和增强的神经体液激活介质的血管收缩。