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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
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Coronary microvascular dysfunction and future risk of heart failure with preserved ejection fraction
Viviany R Taqueti1, Scott D Solomon1, Amil M Shah1
1Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
European Heart Journal
|January 3, 2018
Summary
Impaired coronary flow reserve (CFR) is linked to diastolic dysfunction and increased heart failure with preserved ejection fraction (HFpEF) risk in patients without significant coronary artery disease. Combined microvascular and diastolic dysfunction significantly elevates HFpEF hospitalization risk.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Diagnostic Imaging
Background:
- Heart failure with preserved ejection fraction (HFpEF) pathophysiology involves coronary microvascular ischemia, cardiomyocyte injury, and stiffness.
- The relationship between coronary flow reserve (CFR), myocardial injury, diastolic dysfunction, and HFpEF risk is not well-established.
Purpose of the Study:
- To investigate the association between CFR, myocardial injury, diastolic dysfunction, and the risk of future HFpEF events.
- To determine if impaired CFR predicts adverse cardiovascular outcomes in patients evaluated for coronary artery disease.
Main Methods:
- 201 patients without obstructive coronary artery disease (CAD) or reduced ejection fraction underwent stress myocardial perfusion positron emission tomography, troponin measurement, and echocardiography.
- Coronary flow reserve (CFR) was quantified; diastolic function was assessed using transmitral and tissue Doppler.
- Patients were followed for cardiovascular death, myocardial infarction, or heart failure hospitalization.
Main Results:
- Impaired CFR (<2) correlated with worsening diastolic function (decreasing e', increasing E/e').
- Detectable troponin was associated with diastolic dysfunction only when CFR was impaired.
- Impaired CFR independently predicted diastolic dysfunction and adverse cardiovascular outcomes, including HFpEF hospitalization.
Conclusions:
- In patients without obstructive CAD, impaired CFR is an independent predictor of diastolic dysfunction and adverse cardiovascular events, particularly HFpEF hospitalization.
- The co-existence of coronary microvascular dysfunction and diastolic dysfunction significantly increases the risk of HFpEF events.
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