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Coronary Flow Reserve, Inflammation, and Myocardial Strain: The CIRT-CFR Trial

Viviany R Taqueti1,2, Amil M Shah1,2, Brendan M Everett2,3

  • 1Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

JACC. Basic to Translational Science
|March 13, 2023
PubMed

Insights

Inflammation impacts cardiovascular health. In patients with cardiometabolic disease, reduced coronary flow reserve (CFR) linked to inflammation, suggesting microvascular ischemia may contribute to heart failure.

Area of Science:

  • Cardiovascular Medicine
  • Inflammation Research
  • Heart Failure Pathophysiology

Background:

  • Inflammation is a critical factor in cardiovascular disease outcomes.
  • The precise role of inflammation in the development of heart failure remains unclear.
  • Understanding inflammation's impact on cardiac function is vital for patient care.

Purpose of the Study:

  • To investigate the association between coronary flow reserve (CFR) and inflammation in patients with cardiometabolic disease.
  • To determine if inflammation modifies the relationship between cardiac blood flow and myocardial strain.
  • To explore the potential link between inflammation-mediated microvascular ischemia and heart failure.

Main Methods:

  • Analysis of data from the prospective, multicenter Coronary Flow Reserve to Assess Cardiovascular Inflammation (CIRT-CFR) study, an ancillary study of the Cardiovascular Inflammation Reduction Trial (CIRT).
  • Assessment of coronary flow reserve (CFR) in patients with cardiometabolic disease.
  • Evaluation of inflammation markers and myocardial strain.
  • Statistical analysis to identify independent associations and interactions.

Main Results:

  • Impaired coronary flow reserve (CFR) was independently associated with increased inflammation and myocardial strain.
  • These associations persisted despite well-controlled lipid, glycemic, and hemodynamic profiles.
  • Inflammation was found to modify the relationship between CFR and myocardial strain, disrupting the link between cardiac blood flow and function.

Conclusions:

  • In patients with cardiometabolic disease, impaired CFR is linked to heightened inflammation and myocardial strain.
  • Inflammation appears to disrupt the normal relationship between cardiac blood flow and function.
  • Further research is warranted to confirm if inflammation-driven microvascular ischemia, indicated by reduced CFR, predicts heart failure development.

Keywords:
BMI, body mass indexCAD, coronary artery diseaseCFR, coronary flow reserveCT, computed tomographyGLS, global longitudinal strainHDL, high-density lipoprotein cholesterolHFpEF, heart failure with preserved ejection fractionIL, interleukinLDL, low-density lipoprotein cholesterolLDM, low-dose methotrexateLVEF, left ventricular ejection fractionMBF, myocardial blood flowMI, myocardial infarctionNHLBI, National Heart, Lung, and Blood InstituteNT-proBNP, N-terminal pro–B-type natriuretic peptidePET, positron emission tomographycardiometabolic diseasecardiovascular trial coronary flow reservecoronary microvascular dysfunctionheart failurehsCRP, high-sensitivity C-reactive proteinhsTNT, high-sensitivity troponin Tinflammation

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