The relationship between coronary microvascular dysfunction, atrial fibrillation and heart failure with preserved

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Cevher Ozcan1,2, Tess Allan3, Stephanie A Besser1,2

  • 1Department of Medicine, University of Chicago 5841 S. Maryland Avenue, MC 6080, Chicago, IL 60637, USA.

American Journal of Cardiovascular Disease
|April 5, 2021
PubMed

Insights

Coronary microvascular dysfunction (CMD) is common in patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). This association predicts poor outcomes, highlighting the need for targeted treatment strategies.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Electrophysiology

Background:

  • Coronary microvascular dysfunction (CMD) is a significant factor in myocardial ischemia and is prevalent in heart failure.
  • The relationship between CMD and atrial fibrillation (AF) remains unclear, particularly concerning co-existence with heart failure with preserved ejection fraction (HFpEF).

Purpose of the Study:

  • To investigate the association between CMD, AF, and HFpEF.
  • To determine if CMD increases susceptibility to the combined presence of AF and HFpEF.
  • To assess the clinical outcomes associated with CMD, AF, and HFpEF.

Main Methods:

  • Invasive coronary physiology studies were conducted in patients presenting with chest pain or dyspnea.
  • Coronary microvascular dysfunction (CMD) was defined by impaired coronary flow reserve (CFR) in the absence of obstructive coronary artery disease.
  • Patient data including presence of AF, HFpEF, and clinical outcomes were analyzed.

Main Results:

  • Coronary microvascular dysfunction (CMD) was highly prevalent in patients with AF (61%) and HFpEF (62%), with 71% having both conditions.
  • CMD was a significant predictor of AF with concomitant HFpEF (OR 4.38, P=0.02).
  • Patients with CMD, AF, or HFpEF experienced reduced survival free of HF hospitalization; AF was a strong predictor of CMD (OR 5.5, P=0.02).

Conclusions:

  • Coronary microvascular dysfunction (CMD) is highly prevalent in patients with atrial fibrillation (AF), with or without heart failure with preserved ejection fraction (HFpEF).
  • CMD is linked to adverse clinical outcomes, including the co-occurrence of AF and HFpEF.
  • Understanding the CMD-AF association is crucial for effective treatment strategies and risk stratification in cardiovascular disease prevention.
Abstract

Keywords:
Atrial fibrillationcoronary flow reserveheart failuremicrovascular dysfunction

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