The Mechanisms Associated with Inflammation and Coronary Microvascular Dysfunction in The Heart Failure with Preserved Ejection Fraction

Heart failure (HF) is a complex clinical syndrome, with more than half of the cases classified as heart failure with preserved ejection fraction (HFpEF). HFpEF is strongly associated with comorbidities such as hypertension, obesity, diabetes, anemia, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), advanced age, and female gender. Despite its high prevalence, the exact pathogenesis of HFpEF remains poorly understood, leading to limited therapeutic options and poor prognosis. Recently, a novel paradigm has emerged, suggesting that comorbidities drive myocardial dysfunction and remodeling in HFpEF through coronary microvascular inflammation. This review summarizes the molecular mechanisms linking inflammation to coronary microvascular dysfunction (CMD) in HFpEF and discusses current therapeutic strategies targeting these pathways.