Abstract 18173: Coronary Microvascular Dysfunction in Patients With Heart Failure and Preserved Ejection Fraction
Background: Heart failure with preserved ejection fraction (HFpEF) is associated with high mortality; however, clinical trials have yet to definitively demonstrate improved outcomes. Coronary microvascular dysfunction (CMVD) could serve as a target for future clinical trials. We hypothesize that CMVD is common in HFpEF and is associated with worse symptoms and diastolic dysfunction.
Methods: In a dual-center, prospective study of HFpEF patients (n=16) and controls (n=8), clinical, laboratory, echocardiographic, hemodynamic, and angiographic data were evaluated. All subjects underwent invasive coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) measurements using the thermodilution technique. CFR < 2.5 and IMR > 20 U were considered abnormal. CMVD was defined as having both abnormal CFR and IMR.
Results: The HFpEF cohort was older (64 vs 52 years, p = 0.02) and had higher left ventricular end-diastolic pressure (18 vs 8 mmHg, p = 0.02) compared to controls. The prevalence of CMVD in the HFpEF cohort was 56% vs 25% in the controls (p = 0.16). HFpEF patients had lower CFR (2.2 vs 3.9, p = 0.09) and higher IMR (26 vs 22U, p = 0.35). HFpEF patients with CMVD (n=9) had more NYHA class III-IV symptoms (67 vs 14%, p = 0.04), higher E/e’ (15 vs 11, p = 0.03), and higher pulmonary vascular resistance (184 vs 92 dyn·s/cm5, p=0.03) compared to HFpEF patients without CMVD (n=7). Within the HFpEF cohort, CFR was inversely related to E/e’ (r = -0.66, p < 0.01).
Conclusions: In this pilot study, CMVD was found to be prevalent in a large portion of HFpEF patients. Within the HFpEF cohort, those with CMVD were significantly more symptomatic and had worse diastolic dysfunction and pulmonary hypertension. Additionally, HFpEF patients with a lower CFR had higher non-invasive LV filling pressures. Further investigation into the relationship between CMVD and HFpEF could identify it as an important therapeutic target.
- Coronary microcirculation
- Heart failure
- Interventional cardiology
- Diastolic function
- Coronary heart disease
Author Disclosures: M.M. Gajjar: None. N. Narang: None. K. Dryer: None. R. Sweis: None. D. Schimmel: None. J.Y. Cheng: None. S.S. Mitter: None. A. Yadlapati: None. H. Mkrdichian: None. K. Benzuly: None. M. Lee: None. S.J. Shah: None. J. Blair: None.
- © 2016 by American Heart Association, Inc.