Coronary microvascular dysfunction in patients with heart failure with preserved ejection fraction

There are multiple proposed mechanisms for the pathophysiology of heart failure (HF) with preserved ejection fraction (HFpEF). We hypothesized that coronary microvascular dysfunction is common in these patients. In a prospective, observational study, patients undergoing cardiac catheterization with...

Full description

Saved in:
Bibliographic Details
Published in:American journal of physiology. Heart and circulatory physiology 2018-05, Vol.314 (5), p.H1033-H1042
Main Authors: Dryer, Kathryn, Gajjar, Mark, Narang, Nikhil, Lee, Margaret, Paul, Jonathan, Shah, Atman P, Nathan, Sandeep, Butler, Javed, Davidson, Charles J, Fearon, William F, Shah, Sanjiv J, Blair, John E A
Format: Article
Language:English
Subjects:
Adenosine
Aged
Blood pressure
Brain natriuretic peptide
Cardiovascular system
Case-Control Studies
Catheterization
Coronary artery disease
Coronary Circulation
Coronary Vessels - diagnostic imaging
Coronary Vessels - physiopathology
Diastolic pressure
Ejection fraction
Female
Heart
Heart diseases
Heart failure
Heart Failure - diagnostic imaging
Heart Failure - physiopathology
Humans
Illinois
Male
Microcirculation
Microvasculature
Microvessels - diagnostic imaging
Microvessels - physiopathology
Middle Aged
Patients
Physiology
Prospective Studies
Stenosis
Stroke Volume
Vascular Resistance
Ventricle
Ventricular Function, Left
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:There are multiple proposed mechanisms for the pathophysiology of heart failure (HF) with preserved ejection fraction (HFpEF). We hypothesized that coronary microvascular dysfunction is common in these patients. In a prospective, observational study, patients undergoing cardiac catheterization with HFpEF [left ventricular (LV) ejection fraction ≥ 50% and with clinical HF] were compared with similar patients without HFpEF. Patients with ≥50% stenosis were excluded, and coronary flow reserve (CFR) and the index of microvascular resistance (IMR) were measured after adenosine administration using a guidewire, with CFR ≤ 2 and IMR ≥ 23 being abnormal. Baseline characteristics and CFR and IMR were compared in 30 HFpEF patients and 14 control subjects. Compared with control subjects, HFpEF patients were older (65.4 ± 9.6 vs. 55.1 ± 3.1 yr, P < 0.01), had higher numbers of comorbidities (4.4 ± 1.5 vs. 2.6 ± 1.9, P = 0.002), had higher median B-type natriuretic peptide [161 (interquartile range: 75-511) pg/dl vs. 37 (interquartile range: 18.5-111) pg/dl, P < 0.01], and had higher LV end-diastolic pressure (17.8 ± 4.2 vs. 8.4 ± 4.2, P < 0.01). HFpEF patients had lower CFR (2.55 ± 1.60 vs. 3.84 ± 1.89, P = 0.024) and higher IMR (26.7 ± 10.3 vs. 19.7 ± 9.7 units, P = 0.037) than control subjects. Most (71.4%) control subjects had normal coronary physiology, whereas 36.7% of HFpEF patients had both abnormal CFR and IMR and another 36.7% had either abnormal CFR or IMR. In conclusion, this is the first study that has reported invasively determined CFR and IMR in HFpEF patients. We demonstrated the presence of four distinct coronary physiology groups in HFpEF patients. Investigation into the potential mechanisms for these findings is needed. NEW & NOTEWORTHY In this prospective observational study of patients with heart failure with preserved ejection fraction (HFpEF), we found that patients with HFpEF had more abnormalities of coronary flow and resistance than asymptomatic control patients, indicating that coronary microvascular dysfunction may play a role in the HFpEF disease process.
ISSN:0363-6135
1522-1539
DOI:10.1152/ajpheart.00680.2017