Coronary Hemodynamics in Heart Failure and Effects of Therapeutic Interventions

Background: The abnormalities in coronary hemodynamics in systolic heart failure are frequent. Myocardial oxygen demand and consumption are increased and myocardial perfusion is also impaired, which may result in myocardial ischemia, necrosis, and apoptosis. This is potentially a contributing factor for progressive heart failure. Methods and Results: Neurohormonal abnormalities such as activated renin-angiotensin-aldosterone system, increased adrenergic activity, hemodynamic abnormahties such as decreased left ventricular perfusion pressure, and increased left ventricular diastolic pressure are important mechanisms for myocardial ischemia. Conclusions: Different pharmacologic agents may exert different effects on coronary hemodynamics although changes in systemic hemodynamics may be similar. Some agents may enhance myocardial ischemia and others may decrease it. Thus, an understanding of changes in coronary hemodynamics may have therapeutic implications. (J Cardiac Fail 2009:15:116-123)