Microvascular dysfunction and heart failure with preserved ejection fraction

The impact of coronary microvascular dysfunction (CMD) on parameters of systolic and diastolic function, particularly in patients with heart failure and preserved ejection fraction (HFpEF), is poorly understood. Although these conditions often overlap, their combined impact on parameters of systolic and diastolic function remains unexplored.

Consecutive patients undergoing invasive CMD assessment were enrolled. Systolic function was assessed by global longitudinal strain (GLS), diastolic function by E/E', left atrial reservoir strain (LARS), and non-invasive single-beat pressure-volume relationship stiffness constant (β) estimation.

Of 145 patients, 72 (49.7%) had CMD, 35 (24%) HFpEF, and 23 (16%) both conditions. HFpEF was twice as prevalent in CMD patients as compared to patients without CMD (32% vs. 16%, p = 0.034). Both CMD was associated with parameters of both diastolic (E/E' β = 0.29, p < 0.001, LV stiffness constant β = 0.23; p = 0.006, and LARS β = -0.21, p = 0.02) and systolic function (GLS β = 0.31, p < 0.001). The presence of CMD was associated with an impairment in LV stiffness both in patients with and without HFpEF (p for interaction = 0.044).

HFpEF is highly prevalent in patients with CMD, and CMD is associated with both systolic and diastolic dysfunction. In patients with HFpEF, an additional worsening of diastolic function is observed.