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Blunted coronary flow velocity reserve is associated with impairment in systolic function and functional capacity in
Sílvia Aguiar Rosa1, Luís Rocha Lopes2, Luísa Branco3
1Department of Cardiology, Santa Marta Hospital, Lisbon, Portugal; Heart Center, Hospital da Cruz Vermelha Portuguesa, Lisbon, Portugal.
Insights
Impaired coronary flow velocity reserve (CFVR) in hypertrophic cardiomyopathy (HCM) is linked to reduced ventricular function and exercise capacity. Lower CFVR correlates with poorer systolic function and decreased peak oxygen uptake (VO2).
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Medical Imaging
Background:
- Coronary microvascular dysfunction is a key feature in hypertrophic cardiomyopathy (HCM).
- Understanding the relationship between coronary flow velocity reserve (CFVR) and cardiac function is crucial for HCM management.
Purpose of the Study:
- To investigate the association between impaired CFVR and ventricular systolic function.
- To assess the link between CFVR and functional capacity in patients with HCM.
Main Methods:
- Prospective cohort study of 83 HCM patients.
- Echocardiography used to measure ventricular performance and CFVR in the LAD and PD arteries.
- Cardiopulmonary exercise testing (CPET) evaluated functional capacity (peak VO2).
Main Results:
- Lower CFVR in the posterior descending artery (PD) correlated with impaired global longitudinal strain (GLS) and area strain.
- Reduced CFVR was associated with worse global work indices and efficiency.
- Impaired CFVR in both LAD and PD arteries linked to lower TAPSE and reduced peak VO2.
Conclusions:
- Lower CFVR is associated with impaired biventricular systolic function in HCM patients.
- Reduced CFVR correlates with diminished functional capacity, as indicated by peak VO2.
Background:
Coronary microvascular dysfunction constitutes an important pathophysiological feature in hypertrophic cardiomyopathy (HCM). We aimed to assess the association between impaired coronary flow velocity reserve (CFVR) and ventricular systolic function and functional capacity.
Methods:
Eighty-three patients with HCM were enrolled in this prospective cohort study. Patients underwent echocardiogram to evaluate ventricular performance and CFVR in the left anterior descending artery (LAD) and posterior descending artery (PD). Diastolic coronary flow velocity was measured in basal conditions and in hyperemia. CFVR was calculated as the ratio of hyperemic and basal peak diastolic flow velocities. Functional capacity was evaluated by cardiopulmonary exercise testing (CPET). The link between CFVR and biventricular systolic function and peak VO2 was studied.
Results:
Age was 55.0(14.4)years, 50 patients (60%) were male; 59 patients (71%) had nonobstructive HCM. Mean CFVR LAD was 1.81(0.49) and CFVR PD was 1.73(0.55). Lower CFVR PD was associated with impaired global longitudinal strain (GLS) 2D (β-estimate:-3.240,95%CI:-4.634;-1.846, p < 0.001), GLS 3D (β-estimate:-2.559,95%CI:-3.932;-1.186, p < 0.001) and area strain (β-estimate:-3.044,95%CI:-5.373;-0.716, p = 0.011). Lower values of CFVR PD related to worse global work index (β-estimate:267.824,95%CI:75.964;459.683, p = 0.007), global constructive work (β-estimate:217.300,95%CI:38.750;395.850, p = 0.018) and global work efficiency (β-estimate:5.656,95%CI:2.229;9.084, p = 0.002). Impaired CFVR LAD (β-estimate:2.826, 95%CI:0.913;4.739, p = 0.004) and CFVR PD (β-estimate:2.801,95%CI:0.657;4.945, p = 0.011) were associated with lower TAPSE. Lower values of CFVR LAD (β-estimate:2.580, 95%CI:0.169;4.991, p = 0.036) and CFVR PD (β-estimate:3.163, 95%CI: 0.721;5.606, p = 0.012) were associated with worse peak VO2.
Conclusion:
Lower CFVR was associated with impairment in biventricular systolic function parameters and functional capacity assessed by pVO2.
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