RT Book, Section
A1 Lee, Charlotte
A1 Dec,  G. William
A2 Fuster, Valentin
A2 Narula, Jagat
A2 Vaishnava, Prashant
A2 Leon, Martin B.
A2 Callans, David J.
A2 Rumsfeld, John
A2 Poppas, Athena
SR Print(0)
ID 1191376809
T1 Obstructive and Nonobstructive Coronary Disease in Heart Failure
T2 Fuster and Hurst's The Heart, 15e
YR 2022
FD 2022
PB McGraw-Hill Education
PP New York, NY
SN 9781264257560
LK accesscardiology.mhmedical.com/content.aspx?aid=1191376809
RD 2022/07/03
AB Chapter  SummaryThis  chapter  discusses  the  epidemiology  of  heart  failure  due  to  coronary  atherosclerosis,  as  well  as  the  pathophysiology  and  treatment  options  for  promoting  reverse  remodeling  of  the  left  ventricle  following  myocardial  infarction.  Coronary  artery  disease  remains  the  most  common  etiology  for  heart  failure,  regardless  of  whether  the  phenotype  is  heart  failure  with  reduced  ejection  fraction  (left  ventricular  ejection  fraction  [LVEF]  up  to  40%),  mildly  reduced  ejection  fraction  (LVEF  41%  to  49%),  or  preserved  ejection  fraction  (LVEF  of  at  least  50%)  (see  Fuster  and  Hurst's  Central  Illustration).  The  extent  of  coronary  artery  disease  has  a  direct  bearing  on  clinical  outcome.  While  guideline-directed  pharmacotherapy  remains  a  cornerstone  for  managing  heart  failure  with  reduced  ejection  fraction,  coronary  revascularization  may  improve  quality  of  life  and  outcome  in  patients  with  or  without  symptomatic  angina  pectoris.  Surgical  coronary  revascularization  is  more  effective  than  medical  therapy  alone  in  the  setting  of  hemodynamically  significant  multivessel  disease,  impaired  left  ventricular  function,  ventricular  enlargement,  moderate  or  severe  mitral  regurgitation  and  relatively  preserved  functional  capacity.  Coronary  bypass  grafting  is  more  beneficial  than  multivessel  percutaneous  coronary  intervention  among  diabetic  patients  with  ischemic  cardiomyopathy.  For  heart  failure  with  preserved  ejection  fraction,  the  role  of  microvascular  dysfunction  and  intermittent  ischemia  is  summarized  and  treatment  recommendations,  including  revascularization,  are  discussed.