Key result
Coronary microvascular dysfunction is linked to lower regional diastolic strain rates despite preserved ejection fraction.
Why the study?
Coronary microvascular dysfunction (CMD) is suggested to contribute to HFpEF and left ventricular diastolic dysfunction, prompting evaluation of LV diastolic function in CMD using CMR feature tracking.
Does coronary microvascular dysfunction impair left ventricular diastolic function in patients with INOCA and preserved LVEF?
Observational (n=92)
No
Does coronary microvascular dysfunction impair left ventricular diastolic function in patients with INOCA and preserved LVEF?
Absolute Event Rate: 1.26% vs 1.32%
p-value: p=0.019
CMR feature tracking reveals early regional diastolic impairment in myocardial segments with coronary microvascular dysfunction, providing a potential mechanistic link between CMD and HFpEF.
May signal early diastolic impairment in CMD-INOCA with preserved LVEF; hypothesis-generating for HFpEF link, needing prospective validation.
Background: Coronary microvascular dysfunction (CMD) has been suggested to be one of the pathologic mechanisms contributing to heart failure with preserved left ventricular ejection fraction (LVEF) and left ventricular (LV) diastolic dysfunction. We therefore aimed to evaluate LV diastolic function in patients with CMD using cardiovascular magnetic resonance feature tracking (CMR-FT). Methods: We prospectively enrolled 115 patients referred to cardiology clinics for chest pain assessment who subsequently underwent coronary computed tomography angiogram and stress perfusion CMR. CMD was defined as the presence of subendocardial inducible ischemia detected through visual assessment. LV diastolic function was evaluated using CMR-derived volume-time curves and CMR-FT parameters. The former included early peak filling rate (PFR) and time to PFR; the latter included LV global/regional peak longitudinal diastolic strain rate (LDSR), circumferential diastolic strain rate (CDSR), and radial diastolic strain rate (RDSR). Results: A total of 92 patients with 1,312 segments were eventually included. Of these, 19 patients were classified as non-CMD (48.8±11.2 years; 63.2% male) and 73 as with CMD (52.3±11.9 years; 54.8% male). The LVEFs were similar and preserved in both groups (P=0.266). At the per-patient level, no differences were observed in PFR, time to PFR, or LV global diastolic strain rates between the two groups. At the per-segment level, 51% (665/1,312) of the myocardial segments were classified as CMD, whereas 49% (647/1,312) were classified as non-CMD. CMD segments showed significantly lower regional CDSR (P=0.019) and RDSR (P=0.006) compared with non-CMD segments. Conclusions: Despite normal LV ejection fraction in CMD patients, decreased LV diastolic function in CMD myocardial segments indicates early diastolic impairment.
No takes yet. Share an insight, caveat, or question.
Kong et al. (2023) conducted an observational in Ischemia with no obstructive coronary artery disease (INOCA) and preserved LVEF (n=92). Coronary microvascular dysfunction (CMD) vs. Non-CMD (absence of inducible ischemia) was evaluated on Regional circumferential diastolic strain rate (CDSR) at the per-segment level (p=0.019). Coronary microvascular dysfunction was associated with significantly lower regional circumferential and radial diastolic strain rates in myocardial segments, indicating early diastolic impairment despite normal ejection fraction.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: