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Coronary microvascular dysfunction in patients with heart failure with preserved ejection fraction
Kathryn Dryer1, Mark Gajjar2, Nikhil Narang1
1Section of Cardiology, Department of Medicine, University of Chicago Pritzker School of Medicine , Chicago, Illinois.
American Journal of Physiology. Heart and Circulatory Physiology
|February 10, 2018
Summary
Heart failure with preserved ejection fraction (HFpEF) patients show impaired coronary flow reserve and increased microvascular resistance. These findings suggest coronary microvascular dysfunction is a key factor in HFpEF pathophysiology.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Heart failure with preserved ejection fraction (HFpEF) has multiple proposed pathophysiological mechanisms.
- Coronary microvascular dysfunction is a potential contributor to HFpEF.
Purpose of the Study:
- To investigate the role of coronary microvascular dysfunction in patients with HFpEF.
- To compare coronary flow reserve (CFR) and index of microvascular resistance (IMR) in HFpEF patients versus controls.
Main Methods:
- Prospective observational study involving cardiac catheterization.
- Measurement of CFR and IMR using a guidewire after adenosine administration in 30 HFpEF patients and 14 controls.
- Exclusion of patients with significant coronary artery stenosis (≥50%).
Main Results:
- HFpEF patients were older, had more comorbidities, and higher LV end-diastolic pressure than controls.
- HFpEF patients exhibited significantly lower CFR (2.55 ± 1.60 vs. 3.84 ± 1.89, P = 0.024) and higher IMR (26.7 ± 10.3 vs. 19.7 ± 9.7, P = 0.037).
- Abnormal coronary physiology (both CFR and IMR, or either) was present in 73.4% of HFpEF patients compared to 28.6% of controls.
Conclusions:
- This study provides the first invasive assessment of CFR and IMR in HFpEF patients.
- Coronary microvascular dysfunction is prevalent in HFpEF, characterized by reduced CFR and elevated IMR.
- Further research is warranted to elucidate the mechanisms underlying these coronary physiological abnormalities in HFpEF.
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