Heart failure with preserved ejection fraction: Is ischemia due to coronary microvascular dysfunction a mechanistic factor?

Heart failure with preserved ejection fraction (HFpEF) is increasing in prevalence and has no guideline recommended therapy, related in part to a lack of mechanism. Traditionally, HFpEF was thought to be secondary to afterload overload due to systemic hypertension, however, accumulating evidence suggests that HFpEF continues to worsen despite adequate blood pressure control. Emerging data support the suggestion that myocardial ischemia secondary to coronary microvascular dysfunction could be the new paradigm pathophysiology.