Background: The Heart Failure with Preserved Ejection Fraction (HFpEF) is defined as the preserved
left ventricular ejection fraction (LVEF) with the signs of heart failure, elevated natriuretic peptides, and either
the evidence of the structural heart disease or diastolic dysfunction. The importance of this form of heart failure
was increased after studies where the mortality rates and readmission to the hospital were founded similar as in
patients with HF and reduced EF (HFrEF). Coronary microvascular ischemia, cardiomyocyte injury and stiffness
could be important factors in the pathophysiology of HFpEF. Methods: The goal of this work is to analyse the
relationship of HFpEF and coronary microcirculation in previous studies.
Results: The useful diagnostic marker of coronary microcirculation in HFpEF may be the parameters measured
by transthoracic echocardiography (TTE), the coronary flow reserve (CFR), as well as fractional flow reserve
(FFR) and quantitative myocardial contrast echocardiography (MCE). Cardiac magnetic resonance (CMR) imaging
represents the diagnostic gold standard in HFpEF. Coronary microvascular dysfunction in the absence of
obstructive coronary artery disease (CAD) is poorly understood and may be more prevalent amongst women than
men. Troponin level may be important in risk stratification of HEpEF patients.
Conclusion: There are no precise answers with respect to the pathophysiological mechanism, nor are there any
precise practical clinical assessment of and diagnostic method for coronary microvascular dysfunction and diastolic
dysfunction. In accordance with that, there is no well-established treatment for HFpEF.