BACKGROUND Coronary microvascular inflammation is hypothesized to play a fundamental role in the pathophysiology of heart failure with preserved ejection fraction (HFpEF). No study has directly evaluated both endothelium-dependent and independent coronary microvascular function in HFpEF. METHODS AND RESULTS Consecutive patients with HFpEF undergoing invasive coronary physiologic testing and echocardiography were examined. Endothelial function was quantified by the increase in coronary blood flow in response to intracoronary infusion of acetylcholine (10-6 -10-4 mol/L) using a Doppler flow wire with quantitative angiography. Endothelium-independent coronary microvascular function was assessed by the hyperaemic increase in coronary flow reserve in response to adenosine infusion. Among 162 HFpEF patients (67% women), coronary microvascular function was abnormal in 117 (72%). Isolated endothelium-dependent microvascular dysfunction was present in 47 patients (29%), isolated endothelium-independent microvascular dysfunction in 53 patients (33%), and combined microvascular dysfunction in 17 patients (10%). The presence of coronary microvascular dysfunction was not identifiable from medical co-morbidities or other clinical characteristics. As compared to patients with normal endothelium-independent function, HFpEF patients with endothelium-independent coronary microvascular dysfunction displayed lower diastolic relaxation velocities (7.0 ± 1.8 vs. 8.4 ± 2.9 cm/s, P = 0.002) and higher estimated filling pressures (E/e' 13.1 ± 4.1 vs. 9.6 ± 3.4, P < 0.001). There were no relationships between left ventricular structure, function, or haemodynamics and endothelium-dependent coronary vasodilatation. Endothelium-independent microvascular dysfunction was associated with increased mortality. CONCLUSIONS Coronary microvascular dysfunction is common in patients with HFpEF and is caused equally by endothelium-dependent and independent mechanisms, but the presence of microvascular dysfunction cannot be identified from clinical markers and co-morbidities alone. Patients with HFpEF and endothelium-independent microvascular dysfunction display worse diastolic dysfunction and outcomes.

中文翻译：

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保留射血分数的心力衰竭患者的内皮依赖性和独立性冠状动脉微血管功能障碍。

背景技术假设冠状微血管炎症在射血分数（HFpEF）保持不变的情况下，在心力衰竭的病理生理中起着重要作用。尚无研究直接评估HFpEF中的内皮依赖性和非依赖性冠状动脉微血管功能。方法和结果对连续性HFpEF患者进行了有创冠状动脉生理检查和超声心动图检查。血管内皮功能通过使用定量血管造影术的多普勒导流线对冠状动脉内注入乙酰胆碱（10-6 -10-4 mol / L）的冠状动脉血流量的增加进行定量。内皮依赖性非依赖性冠状动脉微血管功能通过对腺苷输注引起的冠状动脉血流储备的充血增加来评估。在162名HFpEF患者中（女性占67％），117名冠状动脉微血管功能异常（72％）。孤立的内皮依赖性微血管功能障碍存在47例（29％），孤立的内皮依赖性微血管功能障碍存在53例（33％），合并微血管功能障碍的患者17例（10％）。从医学上的合并症或其他临床特征无法确定冠状动脉微血管功能障碍的存在。与内皮独立功能正常的患者相比，具有内皮独立功能的HFpEF患者的冠脉微血管功能障碍表现出较低的舒张舒张速度（7.0±1.8 vs. 8.4±2.9 cm / s，P = 0.002）和较高的估计充盈压（E / e'13.1±4.1与9.6±3.4，P <0.001）。左心室结构，功能，或血流动力学和内皮依赖性冠状血管舒张。不依赖内皮的微血管功能障碍与死亡率增加相关。结论HFpEF患者的冠状动脉微血管功能障碍常见，并且由内皮依赖性机制和独立机制同样引起，但仅凭临床指标和合并症无法确定微血管功能障碍的存在。HFpEF和非内皮依赖性微血管功能障碍的患者表现出更严重的舒张功能障碍和预后。但仅凭临床指标和合并症无法确定微血管功能障碍的存在。HFpEF和非内皮依赖性微血管功能障碍的患者表现出更严重的舒张功能障碍和预后。但仅凭临床指标和合并症无法确定微血管功能障碍的存在。HFpEF和非内皮依赖性微血管功能障碍的患者表现出更严重的舒张功能障碍和预后。