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Arterial stiffness assessment in coronary microvascular dysfunction and heart failure with preserved ejection
P Rezaeian1, C L Shufelt2, J Wei3
1Torrance Memorial Medical Center-A Cedars-Sinai Affiliate, Torrance, CA, USA.
Insights
Heart failure with preserved ejection fraction (HFpEF) patients show increased arterial stiffness and reduced heart function compared to those with suspected coronary microvascular dysfunction (CMD). This suggests stiffness may drive HFpEF progression.
Area of Science:
- Cardiology
- Vascular Biology
- Heart Failure Research
Background:
- Heart failure with preserved ejection fraction (HFpEF) is a common complication of coronary microvascular dysfunction (CMD).
- The specific pathways linking CMD to HFpEF remain unclear.
- Aortic pulse-wave velocity (aPWV) measures large artery stiffness and predicts cardiovascular disease, but its role in CMD and HFpEF is not well understood.
Purpose of the Study:
- To investigate the relationship between arterial stiffness (aPWV) and cardiac function in patients with HFpEF and suspected CMD.
- To characterize aPWV in patients with HFpEF and CMD.
- To explore potential links between vascular stiffness and the progression of CMD to HFpEF.
Main Methods:
- Evaluated 51 women with suspected CMD and 20 patients with HFpEF, all without obstructive coronary artery disease.
- Measured aortic pulse-wave velocity (aPWV) to assess arterial stiffness.
- Utilized cardiac magnetic resonance imaging (CMRI) to evaluate left ventricular (LV) ejection fraction, myocardial perfusion reserve index (MPRI) for CMD, and LV mass-volume ratio for remodeling.
Main Results:
- HFpEF participants were older, had higher BMI, significantly higher aPWV (greater arterial stiffness), and lower MPRI (reduced myocardial perfusion) compared to the suspected CMD group.
- The HFpEF group exhibited lower LVEF after adjusting for cardiovascular risk factors.
- No significant difference in ventricular remodeling was observed between the groups.
Conclusions:
- Patients with HFpEF demonstrate increased arterial stiffness and impaired myocardial perfusion compared to those with suspected CMD.
- These findings suggest that arterial stiffness may be a key factor in the progression from CMD to HFpEF.
- Further prospective studies are warranted to confirm these observations and elucidate the underlying mechanisms.
Background:
Heart failure with preserved ejection fraction (HFpEF) is the most common cardiac complication in patients with coronary microvascular dysfunction (CMD), yet its underlying pathways remain unclear. Aortic pulse-wave velocity (aPWV) is an indicator of large artery stiffness and a predictor for cardiovascular disease. However, aPWV in CMD and HFpEF is not well characterized and may provide understanding of disease progression.
Methods:
Among participants without obstructive coronary artery disease, we evaluated 51 women with suspected CMD and 20 women and men with evidence of HFpEF. All participants underwent aPWV measurement (SphygmoCor, Atcor Medical) with higher aPWV indicating greater vascular stiffness. Cardiac magnetic resonance imaging (CMRI) assessed left ventricular (LV) ejection fraction, CMD via myocardial perfusion reserve index (MPRI), and ventricular remodeling via LV mass-volume ratio. . Statistical analysis was performed using Wilcoxon rank sum tests, Pearson correlations and linear regression analysis.
Results:
Compared to the suspected CMD group, the HFpEF participants were older (65 ± 12 vs 56 ± 11 yrs., p = 0.002) had higher BMI (31.0 ± 4.3 vs 27.8 ± 6.7 kg/m2, p = 0.013), higher aPWV (10.5 ± 2.0 vs 8.0 ± 1.6 m/s, p = 0.05) and lower MPRI (1.5 ± 0.3 vs1.8 ± 0.3, p = 0.02), but not remodeling. In a model adjusted for cardiovascular risk factors, the HFpEF group had a lower LVEF (estimate -4.78, p = 0.0437) than the suspected CMD group.
Conclusions:
HFpEF participants exhibit greater arterial stiffness and lower myocardial perfusion reserve, with lower LVEF albeit not remodeling, compared to suspected CMD participants. These findings suggest arterial stiffness may contribute to progression from CMD to HFpEF. Prospective work is needed and ongoing.
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