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[Impaired coronary flow reserve in patients with non-ischemic heart failure]
Isabel Coma-Canella1, María José García-Velloso, Alfonso Macías
1Departamento de Cardiología. Clínica Universitaria de Navarra. Facultad de Medicina. Universidad de Navarra. Pamplona, Spain. icoma@unav.es
Insights
Coronary microvascular function is impaired in heart failure patients. This impairment worsens with increased heart failure severity, impacting coronary flow reserve (CFR).
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Medical Imaging
Background:
- Coronary flow reserve (CFR) is a key indicator of heart health.
- Impaired CFR is observed in ischemic heart disease and heart failure.
- The relationship between heart failure severity and CFR impairment needs further clarification.
Purpose of the Study:
- To investigate the impact of heart failure severity on CFR.
- To assess coronary microvascular function in non-ischemic heart failure.
Main Methods:
- Studied 40 patients with non-ischemic heart disease and heart failure, categorized into four functional classes.
- Measured myocardial blood flow (MBF) using Positron Emission Tomography (PET) with N-13 ammonia.
- Assessed CFR at rest and during adenosine triphosphate (ATP) infusion.
Main Results:
- Significantly higher MBF and CFR were observed in patients with less severe heart failure (Class I) compared to those with severe heart failure (Class III-IV).
- CFR showed a trend towards being higher in patients with less severe heart failure (Class II) compared to Class I.
- No significant correlation was found between CFR and age, blood pressure, ventricular mass, or ejection fraction.
Conclusions:
- Coronary microvascular dysfunction is present in non-ischemic heart failure.
- The degree of CFR impairment is directly related to the functional class of heart failure.
- Functional class, not the specific underlying heart disease, correlates with microvascular impairment.
Introduction And Objectives:
Coronary flow reserve (CFR) is impaired not only in ischemic heart disease, but also in cardiac diseases that may or may not course with heart failure. The aim of the present study was to determine if the severity of heart failure can influence CFR impairment.
Methods:
Forty patients with non-ischemic heart disease and heart failure were studied 41 times. Four groups were established: 1. 10 patients in functional class III-IV; 2. 10 patients in functional class II not taking beta-blockers; 3. 11 patients in class II treated with carvedilol, and 4. 10 patients in class I. These patients had a history of heart failure and systolic dysfunction. Myocardial blood flow (MBF) was measured with positron emission tomography (PET) and N-13 ammonia at rest (r) and during adenosine triphosphate (ATP) infusion.
Results:
MBF and CFR were significantly higher in group 4 (1.95 0.58 and 2.40 0.95 ml/min/g) than in group 1 (1.02 0.52 and 1.46 0.48 ml/min/g). CFR tended to be higher in groups 2 (1.73 0.72), and 3 (1.89 0.75) vs group 1. No significant correlation was found between CFR and the following variables: age, systolic blood pressure, ventricular mass index, ventricular volume indexes, and ejection fraction.
Conclusions:
Coronary microvascular function is impaired in non-ischemic heart failure, and the impairment is related to functional class, regardless of the underlying responsible heart disease.