Regional differences and coronary microvascular dysfunction in heart failure with preserved ejection fraction.

Area of Science:

• Cardiology
• Heart Failure Research
• Vascular Biology

Background:

• Heart failure with preserved ejection fraction (HFpEF) exhibits diverse clinical phenotypes.
• Coronary microvascular dysfunction (CMD) is a potential unifying feature in HFpEF.
• Understanding regional variations in HFpEF and CMD is crucial for targeted therapies.

Purpose of the Study:

• To investigate regional differences in clinical characteristics of HFpEF patients.
• To determine the prevalence of CMD across different geographic regions in HFpEF.
• To explore if regional factors influence the association between CMD and clinical traits.

Main Methods:

• Analysis of 202 stable HFpEF patients from a multicentre study (Finland, Singapore, Sweden, US).
• Exclusion of patients with unrevascularized macrovascular coronary artery disease.
• Assessment of CMD using Doppler echocardiography, defined as coronary flow reserve < 2.5.

Main Results:

• Significant regional variations in patient demographics and comorbidities (e.g., BMI, hypertension, diabetes, atrial fibrillation, CKD, smoking).
• CMD prevalence ranged from 59% (US) to 88% (Finland), but this difference was not significant after adjusting for covariates.
• No significant interaction between region and clinical characteristics for CMD prevalence was observed.

Conclusions:

• Despite regional clinical heterogeneity, CMD is highly prevalent in HFpEF patients worldwide.
• Observed regional differences in CMD prevalence were attributable to variations in patient characteristics.
• CMD represents a potential common therapeutic target for HFpEF patients across diverse regions.