Impaired coronary flow reserve was associated with a 5-fold increased risk of hospitalization for heart failure with preserved ejection fraction in symptomatic patients without overt CAD.
Does impaired coronary flow reserve increase the risk of diastolic dysfunction and future HFpEF hospitalization in symptomatic patients without flow-limiting CAD or reduced LVEF?
In symptomatic patients without overt CAD, coronary microvascular dysfunction (impaired CFR) is independently associated with worsening diastolic function and a significantly increased risk of future HFpEF hospitalization.
Absolute Event Rate: 0% vs 0%
AIMS: Coronary microvascular ischaemia, cardiomyocyte injury and stiffness may play an important role in the pathophysiology of heart failure with preserved ejection fraction (HFpEF). To date, the relationship between coronary flow reserve (CFR), myocardial injury, diastolic dysfunction, and future HFpEF risk is unknown. METHODS AND RESULTS: Consecutive patients (n = 201) undergoing evaluation for suspected coronary artery disease (CAD) with stress myocardial perfusion positron emission tomography, serum troponin, and transthoracic echocardiography who did not have flow-limiting CAD or reduced left ventricular ejection fraction were identified. Patients were followed up (median 4.1 years) for cardiovascular death and hospitalization for non-fatal myocardial infarction or heart failure. Coronary flow reserve was quantified as stress/rest myocardial blood flow. Early diastolic flow (E) and relaxation (e′) velocities were obtained via transmitral and tissue Doppler, respectively. Patients with impaired CFR ( 15, adjusted OR 2.58, 95%CI 1.22–5.48) and composite cardiovascular outcomes or HFpEF hospitalization alone (adjusted HR 2.47, 95%CI 1.09–5.62). Patients with both impaired CFR and diastolic dysfunction demonstrated >five-fold increased risk of HFpEF hospitalization (P < 0.001). CONCLUSION: In symptomatic patients without overt CAD, impaired CFR was independently associated with diastolic dysfunction and adverse events, especially HFpEF hospitalization. The presence of both coronary microvascular and diastolic dysfunctions was associated with a markedly increased risk of HFpEF events.
Taqueti et al. (Tue,) reported a other. Impaired coronary flow reserve was associated with a 5-fold increased risk of hospitalization for heart failure with preserved ejection fraction in symptomatic patients without overt CAD.