Untangling the Pathophysiologic Link Between Coronary Microvascular Dysfunction and Heart Failure With Preserved Ejection Fraction

Aish Sinha; Haseeb Rahman; Andrew Webb; Ajay M. Shah; Divaka Perera


Eur Heart J. 2021;42(43):4431-4441. 

In This Article


Coronary microvascular disease–HFpEF may be a distinct HFpEF endotype with coronary microvascular dysfunction being the underlying mechanism leading to impaired myocardial reserve. We have scrutinized the role of subendocardial ischaemia and impaired lusitropy in the development of CMD–HFpEF and have explored the challenges in demonstrating causality between CMD and HFpEF. We have also discussed the role of gender in CMD–HFpEF and have explored the limitations of the contemporary HFpEF therapeutic trials targeting the NO–cGMP–PKG pathway. Further longitudinal and mechanistic studies are required to verify the proposed mechanistic link between CMD and HFpEF. A better understanding of the common pathophysiology may pave the way for the development of therapeutic agents that can improve these patients' quality of life and cardiovascular outcomes.