Why do we care about coronary microvascular dysfunction and heart failure with preserved ejection fraction: addressing knowledge gaps for evidence-based guidelines.
Why do we care about coronary microvascular dysfunction and heart failure with preserved ejection fraction: addressing knowledge gaps for evidence-based guidelines.
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为什么我们关心冠状动脉微血管功能障碍和射血分数保留的心力衰竭：解决循证指南的知识差距。
DOI：
10.1093/eurheartj/ehy558
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发表时间：
2018
影响因子：
39.3
通讯作者：
BaireyMerz,CNoel
中科院分区：
文献类型：
--
作者：
Wei,Janet;Nelson,MichaelD;Sharif,Behzad;Shufelt,Chrisandra;BaireyMerz,CNoel
有越来越多的文献表明，冠状动脉微血管功能障碍（CMD）相关的内膜下缺血有助于左心室重塑，舒张和收缩功能障碍，以及随后的射血分数保留心力衰竭（HFpEF）。1迄今为止，射血分数保留的心力衰竭中微血管功能障碍的患病率（PROMIS-HFpEF）（n= 202）是最大的前瞻性、多中心研究（斯堪的纳维亚、美国和新加坡），在已知HFpEF受试者中评价了冠状动脉血流储备（CFR）（CMD的诊断指标）。2在这项研究中，75%的受试者有CMD的证据，定义为通过腺苷负荷经胸多普勒超声心动图测量的CFR< 2.5。研究人员发现，低CFR与N末端前B型利钠肽（NTproBNP）升高以及心脏结构和功能异常（包括左心房和右心室（RV）功能障碍）相关。Shah等人还报告称，低CFR与外周内皮功能障碍相关，通过反应性充血指数（RHI）进行测量。虽然其他研究报告了HFpEF患者的外周血管功能障碍，3但PROMIS-HFpEF研究者首次记录了与CFR的相关性。具体而言，低CFR与肥胖患者的低RHI更密切相关，表明HFpEF是一种可能影响其他器官的全身性血管疾病。
There is increasing documentation that coronary microvascular dysfunction (CMD)-related subendocardial ischaemia contributes to left ventricular remodeling, diastolic and systolic dysfunction, and subsequent heart failure with preserved ejection fraction (HFpEF). 1 To date, prevalence of microvascular dysfunction in heart failure with preserved ejection fraction (PROMIS-HFpEF)(n= 202) is the largest prospective, multicentre study (Scandinavia, USA, and Singapore) evaluating coronary flow reserve (CFR), a diagnostic measure of CMD, in subjects with known HFpEF. 2 In this study, 75% of the subjects had evidence of CMD, defined as CFR< 2.5 measured by adenosine stress transthoracic Doppler echocardiography. The investigators found that low CFR is associated with elevated N-terminal pro b-type natriuretic peptide (NTproBNP), and abnormal cardiac structure and function including left atrial and right ventricular (RV) dysfunction. Shah et al. also report that low CFR is associated with peripheral endothelial dysfunction, as measured by reactive hyperemia index (RHI). While other studies have reported peripheral vascular dysfunction in patients with HFpEF, 3 the PROMIS-HFpEF investigators are the first to document an association with CFR. Specifically, low CFR is more strongly associated with low RHI in obesity, suggesting that HFpEF is a systemic vascular disorder that potentially impacts other organs.