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Updated: Jan 24, 2026
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Overlap between angina without obstructive coronary artery disease and left ventricular diastolic dysfunction with
Marie Mide Michelsen1, Adam Pena2, Naja D Mygind3
1Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
Insights
Women experiencing angina without obstructive coronary artery disease (CAD) show impaired left ventricular diastolic function. This finding suggests a shared pathway between angina and heart failure with preserved ejection fraction.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Echocardiography
Background:
- A potential link between angina with no obstructive coronary artery disease (CAD) and heart failure with preserved ejection fraction (HFpEF) is suggested but lacks robust evidence.
- Investigating left ventricular diastolic function in women with angina and no obstructive CAD is crucial for understanding this relationship.
Purpose of the Study:
- To compare left ventricular diastolic function in women with angina and no obstructive CAD against a reference population.
- To explore potential shared pathophysiological mechanisms between angina and HFpEF.
Main Methods:
- A cross-sectional study involving 956 women with angina and <50% coronary artery stenosis.
- A control group of 214 women with cardiovascular risk factors but no history of cardiac symptoms.
- Left ventricular diastolic function assessed using transthoracic echocardiography.
Main Results:
- Women with angina exhibited impaired diastolic function, including lower E/A ratio and higher left ventricular mass index, left atrial volume index, and E/e' ratio.
- A greater proportion of angina patients had elevated left ventricular filling pressures compared to controls.
- These differences remained significant after adjusting for cardiovascular risk factors.
Conclusions:
- Patients with angina and no obstructive CAD demonstrate significantly impaired left ventricular diastolic function compared to asymptomatic individuals.
- The findings suggest a common pathophysiological pathway linking angina with no obstructive CAD and heart failure with preserved ejection fraction.
Background:
A link between angina with no obstructive coronary artery disease (CAD) and heart failure with preserved left ventricular ejection fraction has been proposed, but evidence in support of this is lacking. In a cross-sectional study, we investigated whether left ventricular diastolic function in women with angina pectoris and no obstructive CAD differed from a reference population.
Methods:
We included 956 women with angina and <50% coronary artery stenosis at invasive coronary angiography. Women with cardiovascular risk factors, but no history of chest pain or cardiac disease served as controls (n = 214). Left ventricular diastolic function was assessed by transthoracic echocardiography.
Results:
The women with angina were slightly older, had higher body mass index, higher heart rate, and more had diabetes compared with controls while systolic blood pressure was lower. In age-adjusted analyses, angina patients had significantly lower E/A (Estimated difference -0.13, 95% CI: -0.17; -0.08), higher left ventricular mass index (5.73 g/m2, 95% CI: 3.71; 7.75), left atrial volume index (2.34 ml/m2, 95% CI: 1.23; 3.45) and E/e' (0.68, 95% CI: 0.30; 1.05) and a larger proportion had higher estimated left ventricular filling pressure (17% versus 6%, p = 0.001). No between group differences were seen for e' or deceleration time. After adjustment for known cardiovascular risk factors, between group differences for echocardiographic parameters remained statistically significant.
Conclusions:
Patients with angina and no obstructive CAD had a more impaired left ventricular diastolic function compared with an asymptomatic reference population. This suggests some common pathophysiological pathway between the two syndromes.
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