# Microvasculaire dysfunctie bij HFpEF: pathofysiologie en behandelopties

*geplaatst 2026-09-02 · Hartfalen · Cardiology in review · doi 10.1097/CRD.0000000000001442 · https://hartvaat.nl/2026/08/26/microvasculaire-dysfunctie-bij-hfpef-pathofysiologie-en-behandelopties/*

Coronair microvasculair disease komt bij ongeveer driekwart van de patiënten met hartfalen met behouden ejectiefractie (HFpEF) voor, zelfs zonder obstructieve epicardiale coronaire ziekte. De review belicht de gedeelde pathofysiologische mechanismen, zoals endoteliële dysfunctie en mitochondriale stoornissen, en benadrukt dat microvasculaire dysfunctie bij HFpEF steeds vaker als een specifiek endotype wordt gezien. Voor de klinische praktijk zijn er aanwijzingen dat levensstijlinterventies, richtlijnconforme medicatie en SGLT2-remmers de microcirculatie kunnen verbeteren en de uitkomst voor deze patiëntengroep positief beïnvloeden.

## English: Coronary Microvascular Disease in Heart Failure With Preserved Systolic Function: Pathogenic Mechanisms and Therapeutic Options-A Narrative Review.

Coronary microvascular disease affects up to 75% of patients with heart failure with preserved ejection fraction (HFpEF), even in the absence of obstructive epicardial coronary artery disease. This narrative review outlines the shared pathophysiological pathways, including endothelial dysfunction and mitochondrial impairment, positioning microvascular dysfunction as a distinct HFpEF endotype. Clinically, the findings support integrating lifestyle modifications, guideline-directed medical therapy, and SGLT2 inhibitors to target the microvasculature and improve outcomes in this prevalent patient population.

## Abstract (original, from the publication)

Heart failure with preserved ejection fraction accounts for approximately half of all heart failure cases globally and is associated with substantial morbidity and mortality. Coronary microvascular disease has emerged as a critical and highly prevalent comorbidity in heart failure with preserved ejection fraction, affecting up to 75% of patients in the absence of obstructive epicardial coronary artery disease. Coronary microvascular disease is characterized by impaired vasodilation or enhanced vasoconstriction of the coronary microcirculation through both endothelial-dependent and endothelial-independent mechanisms. This review synthesizes contemporary evidence on the epidemiology, pathophysiology, diagnostic approaches, prognostic implications, and therapeutic strategies for coronary microvascular disease in heart failure with preserved ejection fraction. The pathophysiological overlap between these two conditions is substantial, involving shared inflammatory pathways, oxidative stress, endothelial dysfunction, microvascular rarefaction, and mitochondrial impairment. Although a direct causal relationship remains to be definitively established, coronary microvascular disease-heart failure with preserved ejection fraction is increasingly recognized as a distinct endotype with unique therapeutic implications. Emerging evidence supports the role of lifestyle interventions, guideline-directed medical therapy, sodium-glucose cotransporter 2 inhibitors, and novel investigational approaches in targeting the microvasculature to improve outcomes in this patient population.

Auteurs: Shijun Li

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Bron: Cardiology in review, https://doi.org/10.1097/CRD.0000000000001442. Bijgewerkt 2026-08-27T01:05:09Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.