冠状动脉微循环障碍在射血分数保留的心力衰竭中的作用机制及治疗进展

Research Progress in Mechanism and Treatment of Coronary Microcirculation Dysfunction in Heart Failure with Preserved Ejection Fraction

射血分数保留的心力衰竭(HFpEF)是一种重要的心力衰竭表型,目前其患病率、住院率和死亡率呈升高趋势。HFpEF的病理生理机制涉及代谢紊乱、心肌纤维化、系统性炎症、心外膜脂肪堆积等多方面因素,因此HFpEF有效的治疗方法尚未明确。HFpEF常伴有多种合并症,冠状动脉微循环障碍(CMD)在HFpEF的发生、发展过程中起重要作用,如微血管内皮炎症、微血管稀疏及微血管缺血引起CMD参与HFpEF的左心室向心性重构、左心室舒张功能障碍及心肌纤维化等过程。因此,CMD可能是未来治疗HFpEF的有效靶点。

Heart failure with preserved ejection fraction(HFpEF)is an important phenotype of heart failure,and the morbidity,hospitalization rate and mortality rate are increasing at present.The pathophysiological mechanism of HFpEF involves many factors,such as metabolic disorder,myocardial fibrosis,systemic inflammation,epicardial fat accumulation and so on.Therefore,the effective treatment of HFpEF has not been clear.HFpEF is often accompanied by a variety of comorbidities,and it has been found that coronary microcirculation dysfunction(CMD)plays an important role in the occurrence and development of HFpEF.For example,microvascular endothelial inflammation,microvascular sparseness and microvascular ischemia cause CMD to participate in the left ventricular centripetal remodeling,left ventricular diastolic dysfunction and myocardial fibrosis of HFpEF.Therefore,CMD may be an effective target for the future treatment of HFpEF.