The Role of Coronary Microvascular Dysfunction in Heart Failure With Preserved Ejection Fraction
Heart failure with preserved ejection fraction (HFpEF) accounts for approximately half of the 64 million people living globally with heart failure and is associated with significant morbidity and mortality. Therapeutic options for HFpEF remain limited, largely due to an incomplete understanding of its complex pathophysiology. A growing body of evidence has highlighted coronary microvascular dysfunction (CMD) as a driver of both the development and progression of HFpEF. CMD is prevalent in up to 75% of HFpEF patients in the absence of obstructive epicardial disease and is associated with increased rates of rehospitalization and mortality. Despite this, CMD is often underdiagnosed in this patient population. A more comprehensive understanding of the link between HFpEF and CMD could provide novel targeted therapeutic strategies. This review aims to elucidate the prognostic significance of CMD in HFpEF, pathophysiologic links between these 2 conditions, and the role of CMD in current and future therapeutic interventions.
Authors
- Danielle N. Tapp (ORCID: https://orcid.org/0009-0004-3561-7542)
- Timothy D. Henry (ORCID: https://orcid.org/0000-0003-1123-0533)
- Michael C. Honigberg (ORCID: https://orcid.org/0000-0001-8630-5021)
- Glaucia Moraes de Oliveira
- Odayme Quesada (ORCID: https://orcid.org/0000-0002-7285-5994)
- Daniela R. Crousillat (ORCID: https://orcid.org/0000-0001-8403-2445)
- Andreas Tzoumas (ORCID: https://orcid.org/0000-0002-7903-6975)
- Colleen Harrington (ORCID: https://orcid.org/0000-0002-2830-9953)
- Joan Briller (ORCID: https://orcid.org/0000-0003-1477-4245)
- Patricia Rodriguez-Lozano
- Imo Ebong (ORCID: https://orcid.org/0000-0001-9687-7541)
- Niti R. Aggarwal
- Selma F. Mohammed (ORCID: https://orcid.org/0000-0003-3553-2720)
- C. Noel Bairey Merz (ORCID: https://orcid.org/0000-0002-9933-5155)
Institutions
- Broad Institute (US)
- Creighton University (US)
- Universidade Federal do Rio de Janeiro (BR)
- Cedars-Sinai Medical Center (US)
- Mayo Clinic (US)
- University of South Florida (US)
- University of Illinois Chicago (US)
- University of Chicago (US)
- Massachusetts General Hospital (US)
- University of Virginia Medical Center (US)
- Cedars-Sinai Smidt Heart Institute (US)
- Christ Hospital (US)
- University of California, Davis (US)
Publication Details
- Journal
- JACC Advances
- Published
- 2025-11-20
- DOI
- https://doi.org/10.1016/j.jacadv.2025.102345
- Citations
- 1
- Primary Topic
- Cardiovascular Function and Risk Factors
- Type
- article
- Field-Weighted Citation Impact
- 1.39