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 2023/02/07 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.