The Role of Systemic Microvascular Dysfunction in Heart Failure with Preserved Ejection Fraction

Jerremy Weerts*, Sanne G. J. Mourmans, Arantxa Barandiarán Aizpurua, Blanche L. M. Schroen, Christian Knackstedt, Etto Eringa, Alfons J. H. M. Houben, Vanessa P. M. van Empel

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review


Heart failure with preserved ejection fraction (HFpEF) is a condition with increasing incidence, leading to a health care problem of epidemic proportions for which no curative treatments exist. Consequently, an urge exists to better understand the pathophysiology of HFpEF. Accumulating evidence suggests a key pathophysiological role for coronary microvascular dysfunction (MVD), with an underlying mechanism of low-grade pro-inflammatory state caused by systemic comorbidities. The systemic entity of comorbidities and inflammation in HFpEF imply that patients develop HFpEF due to systemic mechanisms causing coronary MVD, or systemic MVD. The absence or presence of peripheral MVD in HFpEF would reflect HFpEF being predominantly a cardiac or a systemic disease. Here, we will review the current state of the art of cardiac and systemic microvascular dysfunction in HFpEF (Graphical Abstract), resulting in future perspectives on new diagnostic modalities and therapeutic strategies.
Original languageEnglish
Article number278
Issue number2
Publication statusPublished - 1 Feb 2022

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