What is the clinical evidence from this study?

Study design: Observational. Population: Ischemia with Non-Obstructive Coronary Arteries (INOCA) (n=85). Primary outcome: Prevalence of heart failure with preserved ejection fraction (HFpEF).

What question did this study set out to answer?

To evaluate the prevalence of heart failure with preserved ejection fraction (HFpEF) in patients with ischemia and non-obstructive coronary arteries (INOCA).

March 16, 2026Open Access

Prevalence of heart failure with preserved ejection fraction in patients with ischemia and non-obstructive coronary arteries

Q: What does this research mean for the field?

Heart failure with preserved ejection fraction (HFpEF) is highly prevalent, occurring in approximately 35% of patients with ischemia and non-obstructive coronary arteries (INOCA). Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Heart failure with preserved ejection fraction (HFpEF) was diagnosed in 35.29% (30) of INOCA patients, indicating a significant prevalence of this condition in this population.

Key Points

To evaluate the prevalence of heart failure with preserved ejection fraction (HFpEF) in patients with ischemia and non-obstructive coronary arteries (INOCA).
Prospective enrollment of INOCA patients for comprehensive coronary function assessments.
Utilized transthoracic echocardiography to diagnose HFpEF according to European Society of Cardiology criteria.
Analysis of endothelial dysfunction using acetylcholine response.
35.29% of INOCA patients were diagnosed with HFpEF.
94.12% exhibited an abnormal response to acetylcholine, indicating endothelial dysfunction or vasospasm.
80% showed both endothelial dysfunction and coronary artery spasm.

Study Design

Type

Observational (n=85)

Multicenter

Structured PICO

Population

85 consecutive adult patients with ischemia and non-obstructive coronary arteries (INOCA), median age 66, 64.71% women. Key inclusion: symptomatic chronic coronary syndrome (CCS) class II or higher, confirmed non-obstructive CAD. Key exclusions: history of coronary revascularization, expected survival <1 year, >mild valvular lesions, HFrEF, atrial fibrillation, or chronic kidney disease.

Outcome

Prevalence of heart failure with preserved ejection fraction (HFpEF) diagnosed according to European Society of Cardiology criteria

HFpEF is highly prevalent (35.3%) among patients with INOCA, suggesting that routine noninvasive HFpEF screening should be considered as part of their initial diagnostic evaluation.

Limitations

No formal sample size calculation was performed.
Patients were excluded due to insufficient echocardiographic image quality.

Abstract

Coronary microvascular disease is a key factor in the pathogenesis of ischemia with non-obstructive coronary arteries (INOCA) and heart failure with preserved ejection fraction (HFpEF). However, the occurrence of HFpEF in INOCA patients remains poorly understood. This study aimed to evaluate the prevalence of HFpEF in INOCA patients.We prospectively enrolled consecutive INOCA patients who underwent comprehensive coronary function assessments and transthoracic echocardiography. HFpEF was diagnosed according to European Society of Cardiology criteria. The study was registered at ClinicalTrials.gov (NCT05313919). We prospectively enrolled consecutive INOCA patients who underwent comprehensive coronary function assessments and transthoracic echocardiography. HFpEF was diagnosed according to European Society of Cardiology criteria. The study was registered at ClinicalTrials.gov (NCT05313919). We evaluated a total of 85 INOCA patients, of whom 64.71% (55) were women, with a median age of 66 years (IQR 59–71). An abnormal response to acetylcholine, defined as endothelial dysfunction and/or inducible vasospasm, was observed in 94.12% (80) of the group, with the most common finding being concurrent endothelial dysfunction and coronary artery spasm, affecting 80% (68) of subjects. Notably, HFpEF was diagnosed in 35.29% (30) of patients. HFpEF is common among patients with INOCA. These results support routine noninvasive HFpEF screening as part of the initial diagnostic evaluation. Early recognition may identify a large subgroup eligible for guideline-directed HFpEF therapies, enabling more personalized management and potentially improving outcomes.

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