Key result
CMD in HFpEF is linked to ~219% higher risk of death or heart failure hospitalization.
Why the study?
Coronary microvascular dysfunction may play a key pathophysiological role in HFpEF, but its prevalence, echocardiographic correlates, and prognostic implications needed investigation.
Does the presence of coronary microvascular dysfunction worsen clinical outcomes and echocardiographic parameters in patients with HFpEF?
Meta-Analysis (n=1,138)
Does the presence of coronary microvascular dysfunction worsen clinical outcomes and echocardiographic parameters in patients with HFpEF?
Coronary microvascular dysfunction is present in over half of HFpEF patients and is associated with worse diastolic dysfunction, more atrial fibrillation, and a tripled risk of death or HF hospitalization.
CMD may aid risk stratification in HFpEF; leaves open whether microvascular-targeted therapies improve outcomes.
AIMS: Several mechanisms have been identified in the aetiopathogenesis of heart failure with preserved ejection fraction (HFpEF). Among these, coronary microvascular dysfunction (CMD) may play a key pathophysiological role. We performed a systematic review and meta-analysis to investigate the prevalence, echocardiographic correlates, and prognostic implications of CMD in patients with HFpEF. METHODS AND RESULTS: A systematic search for articles up to 1 May 2023 was performed. The primary aim was to assess the prevalence of CMD. Secondary aims were to compare key echocardiographic parameters (E/e' ratio, left atrial volume index [LAVi], and left ventricular mass index [LVMi]), clinical outcomes [death and hospitalization for heart failure (HF)], and prevalence of atrial fibrillation (AF) between patients with and without CMD. Meta-regressions according to baseline patient characteristics and study features were performed to explore potential heterogeneity sources. We identified 14 observational studies, enrolling 1138 patients with HFpEF. The overall prevalence of CMD was 58%. Compared with patients without CMD, patients with HFpEF and CMD had larger LAVi [mean difference (MD) 3.85 confidence interval (CI) 1.19-6.5, P < 0.01)], higher E/e' ratio (MD 2.76 CI 1.54-3.97; P < 0.01), higher prevalence of AF (odds ratio 1.61 CI 1.04-2.48, P = 0.03) and higher risk of death or hospitalization for HF [hazard ratio 3.19, CI 1.04-9.57, P = 0.04]. CONCLUSIONS: CMD is present in little more than half of the patients with HFpEF and is associated with echocardiographic evidence of more severe diastolic dysfunction and a higher prevalence of AF, doubling the risk of death or HF hospitalization.
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D’Amario et al. (2024) conducted a meta-analysis in Heart failure with preserved ejection fraction (HFpEF) (n=1,138). Coronary microvascular dysfunction (CMD) vs. Patients without CMD was evaluated on Prevalence of CMD. Coronary microvascular dysfunction was present in 58% of HFpEF patients and was associated with a higher risk of death or heart failure hospitalization (HR 3.19; 95% CI 1.04-9.57; P=0.04).
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