Heart failure

HFpEF Is Associated With High Risk for Coronary Microvascular Dysfunction

Patients with heart failure with preserved ejection fraction (HFpEF) have a high prevalence of coronary microvascular dysfunction (CMD) in the absence of unrevascularized macrovascular coronary artery disease (CAD), according to a recent multinational study. Smoking and atrial fibrillation increase their risk for CMD significantly.

 

Moreover, patients who have CMD also have a higher risk for impaired coronary flow reserve (CFR). 

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The researchers conducted the PROMIS-HFpEF study in 5 sites around the world: Stockholm, Sweden; Chicago, Illinois; Turku, Finland; Sahlgrenska, Sweden; and Singapore.

 

Patients were enrolled if they fit the criteria for HFpEF according to current guidelines and did not have unrevascularized macrovascular CAD at baseline. CFR was defined as less than 2.5.

 

CFR was measured via adenosine stress transthoracic Doppler echocardiography, and systemic endothelial function was measured via peripheral arterial tonometry.

 

Overall, 263 participants were enrolled in the study. Of those, 202 participants had HFpEF and were included in the analysis.

 

Results showed that 151 (75%) participants had evidence of CMD. Current or prior smoking and atrial fibrillation were associated with an increased prevalence of CMD.

 

After adjusting for sex, age, and other variables, worse CFR was associated with:

  • Higher urinary albumin-to-creatinine ratio and NTproBNP; and
  • Lower RHI, tricuspid annular plane systolic excursion, and right ventricular free wall strain.

 

“Impaired coronary microvascular function is highly prevalent in HFpEF patients and is associated with NTproBNP (a marker of HF severity), systemic endothelial dysfunction, and cardiac dysfunction,” the researchers concluded. “Microvascular dysfunction may be a promising composite risk marker and therapeutic target in HFpEF.”

 

—Colleen Murphy

 

Reference:

Shah SJ, Lam CSP, Svedlund S, et al. Prevalence and correlates of coronary microvascular dysfunction in heart failure with preserved ejection fraction: PROMIS-HFpEF. Eur Heart J. 2018;39(37):3439-3450. https://doi.org/10.1093/eurheartj/ehy531.