AimsSeveral mechanisms have been identified in the aetiopathogenesis of heart failure with preserved ejection fraction (HFpEF). Among these, coronary microvascular dysfunction (CMD) may play a key pathophysiological role. We performed a systematic review and meta‐analysis to investigate the prevalence, echocardiographic correlates, and prognostic implications of CMD in patients with HFpEF.Methods and resultsA systematic search for articles up to 1 May 2023 was performed. The primary aim was to assess the prevalence of CMD. Secondary aims were to compare key echocardiographic parameters (E/e′ ratio, left atrial volume index [LAVi], and left ventricular mass index [LVMi]), clinical outcomes [death and hospitalization for heart failure (HF)], and prevalence of atrial fibrillation (AF) between patients with and without CMD. Meta‐regressions according to baseline patient characteristics and study features were performed to explore potential heterogeneity sources. We identified 14 observational studies, enrolling 1138 patients with HFpEF. The overall prevalence of CMD was 58%. Compared with patients without CMD, patients with HFpEF and CMD had larger LAVi [mean difference (MD) 3.85 confidence interval (CI) 1.19–6.5, P < 0.01)], higher E/e′ ratio (MD 2.76 CI 1.54–3.97; P < 0.01), higher prevalence of AF (odds ratio 1.61 CI 1.04–2.48, P = 0.03) and higher risk of death or hospitalization for HF [hazard ratio 3.19, CI 1.04–9.57, P = 0.04].ConclusionsCMD is present in little more than half of the patients with HFpEF and is associated with echocardiographic evidence of more severe diastolic dysfunction and a higher prevalence of AF, doubling the risk of death or HF hospitalization.

中文翻译：

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冠状动脉微血管功能障碍对射血分数保留的心力衰竭的影响：一项荟萃分析

目的 射血分数保留型心力衰竭 (HFpEF) 的发病机制已确定了多种机制。其中，冠状动脉微血管功能障碍（CMD）可能发挥关键的病理生理作用。我们进行了系统回顾和荟萃分析，以调查 HFpEF 患者 CMD 的患病率、超声心动图相关性和预后影响。方法和结果对截至 2023 年 5 月 1 日的文章进行了系统搜索。主要目的是评估 CMD 的患病率。次要目标是比较关键超声心动图参数（E/e' 比、左心房容积指数 [LAVi] 和左心室质量指数 [LVMi]）、临床结果 [因心力衰竭 (HF) 死亡和住院] 以及心衰患病率患有和不患有 CMD 的患者之间的心房颤动 (AF)。根据基线患者特征和研究特征进行荟萃回归，以探索潜在的异质性来源。我们确定了 14 项观察性研究，招募了 1138 名 HFpEF 患者。 CMD 的总体患病率为 58%。与无 CMD 的患者相比，患有 HFpEF 和 CMD 的患者 LAVi 更大 [平均差 (MD) 3.85 置信区间 (CI) 1.19–6.5，磷< 0.01)]，较高的 E/e' 比值 (MD 2.76 CI 1.54–3.97；磷< 0.01），房颤患病率较高（比值比 1.61 CI 1.04–2.48，磷= 0.03），心力衰竭死亡或住院的风险较高[风险比 3.19，CI 1.04–9.57，磷= 0.04]。结论 略多于一半的 HFpEF 患者存在 CMD，并且与超声心动图显示更严重的舒张功能障碍和更高的 AF 患病率相关，使死亡或 HF 住院的风险加倍。