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VIEWPOINT

Acute Heart Failure Syndromes and Coronary Perfusion

Nirat Beohar, MD, FACC^_*,_*, Ata K. Erdogan, MD^_*, Daniel C. Lee, MD^_*, Hani N. Sabbah, PhD, FACC, Morton J. Kern, MD, FACC, John Teerlink, MD, FACC, Robert O. Bonow, MD, FACC^_* and Mihai Gheorghiade, MD, FACC^_*

^_* Feinberg School of Medicine, Northwestern University, Chicago, Illinois
Henry Ford Health System, Detroit, Michigan
University of California, Irvine, California
University of California, San Francisco, California.

Manuscript received January 28, 2008; revised manuscript received March 18, 2008, accepted March 24, 2008.

^_* Reprint requests and correspondence: Dr. Nirat Beohar, Bluhm Cardiovascular Institute, Feinberg School of Medicine, 8-790A Feinberg Pavilion, 251 East Huron Street, Northwestern Memorial Hospital, Chicago, Illinois 60611. (Email: n-beohar{at}northwestern.edu).

Acute heart failure syndromes (AHFS), with a high post-discharge mortality and rehospitalization rate, represent a significant public health burden. The treatment of patients hospitalized with AHFS often includes the use of vasoactive medications such as inotropes and vasodilators. Although such agents are frequently used, their safety and efficacy remain controversial. A significant number of patients with heart failure have underlying coronary artery disease and may be at greater risk from hemodynamic alterations that can diminish coronary perfusion. In AHFS, the relationship among vasoactive medications, coronary perfusion, and potential myocardial injury needs further investigation. Newer techniques now available to evaluate coronary perfusion should provide guidance for the evaluation of existing and future vasoactive therapies for AHFS.

Key Words: acute heart failure syndromes • coronary artery disease • coronary perfusion • microcirculation

Abbreviations and Acronyms   AHFS = acute heart failure syndromes   CAD = coronary artery disease   CFR = coronary flow reserve   FFR = fractional flow reserve   HSR = hyperemic stenosis resistance   IMR = index of microcirculatory resistance   rCFR = relative coronary flow reserve   SPECT = single-photon emission computed tomography

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