Coronary microcirculation and hypertensive heart failure
Key result
Coronary microvascular dysfunction and abnormal ventricular mechanics independently predicted heart failure hospitalization over a median 9-year follow-up in 194 hypertensive patients.
Why the study?
Do coronary microvascular dysfunction and abnormal global longitudinal strain predict heart failure hospitalization in hypertensive patients?
Population
194 hypertensive patients with preserved LVEF who had undergone combined 82Rubidium or [13N]ammonia positron…
Design
Editorial
Follow-up
median nearly 9 years
Authors
Discussion
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Implication
Coronary microvascular dysfunction and abnormal global longitudinal strain provide incremental prognostic value for predicting heart failure in hypertensive patients, even those with normal LV remodeling.
Key Points
- The aim is to highlight the impact of coronary microvascular dysfunction and myocardial mechanics in predicting heart failure in hypertensive patients.
- Retrospective analysis of hypertensive patients undergoing PET-CT and echocardiography.
- Utilization of myocardial perfusion metrics and global longitudinal strain to assess cardiac health.
- Association of coronary microvascular dysfunction with hospitalizations for heart failure was evaluated over nearly 9 years.
- Coronary microvascular dysfunction was linked to increased heart failure hospitalization rates in hypertensive patients with preserved left ventricular ejection fraction.
- Both coronary microvascular dysfunction and abnormal myocardial mechanics independently predicted heart failure outcomes.
- Patients with normal left ventricular remodelling but with CMD showed poorer outcomes similar to those with maladaptive remodelling.
Structured PICO
Do coronary microvascular dysfunction and abnormal global longitudinal strain predict heart failure hospitalization in hypertensive patients?
P
Population
194 hypertensive patients who underwent combined PET-CT and TTE studies at baseline, followed for a median of nearly 9 years.
E
Exposure
Assessment of coronary microvascular dysfunction (CMD) via PET-CT and subclinical myocardial mechanical abnormalities (abnormal global longitudinal strain) via TTE
O
Outcome
First occurrence of HF hospitalizationhard clinical
Coronary microvascular dysfunction and abnormal global longitudinal strain provide incremental prognostic value for predicting heart failure in hypertensive patients, even those with normal LV remodeling.
Limitations
- Retrospective design causing potential case selection bias (only 8% of eligible patients included).
- Cannot rule out the contribution of obesity to cardiac remodelling.
- Absence of haemodynamically significant obstructive lesions does not preclude epicardial coronary artery dysfunction.
- Retrospective design causing case selection (only 8% of eligible patients included)
- Cannot answer whether CMD or abnormal GLS predict the shift from adaptive to maladaptive LV remodelling
- Absence of haemodynamically significant obstructive lesions does not preclude segmental or diffuse dysfunction of epicardial coronary arteries
- Cannot rule out the contribution of obesity to cardiac remodelling
Cite This Study
Escaned et al. (2020) conducted an editorial in Hypertension (n=194). Coronary microvascular dysfunction and abnormal global longitudinal strain vs. Normal microvascular function and normal global longitudinal strain was evaluated on First occurrence of HF hospitalization. Coronary microvascular dysfunction and abnormal ventricular mechanics independently predicted heart failure hospitalization over a median 9-year follow-up in 194 hypertensive patients.