Prevalence of coronary artery disease and coronary microvascular dysfunction in patients with heart failure with preserved ejection fraction

Rush, C. J. et al. (2021) Prevalence of coronary artery disease and coronary microvascular dysfunction in patients with heart failure with preserved ejection fraction. JAMA Cardiology, 6(10), pp. 1130-1143. (doi: 10.1001/jamacardio.2021.1825) (PMID:34160566) (PMCID:PMC8223134)

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Importance: Coronary artery disease (CAD) and coronary microvascular dysfunction (CMD) may contribute to the pathophysiologic characteristics of heart failure with preserved ejection fraction (HFpEF). However, the prevalence of CAD and CMD have not been systematically studied. Objective: To examine the prevalence of CAD and CMD in hospitalized patients with HFpEF. Design, Setting, and Participants: A total of 106 consecutive patients hospitalized with HFpEF were evaluated in this prospective, multicenter, cohort study conducted between January 2, 2017, and August 1, 2018; data analysis was performed from March 4 to September 6, 2019. Participants underwent coronary angiography with guidewire-based assessment of coronary flow reserve, index of microvascular resistance, and fractional flow reserve, followed by coronary vasoreactivity testing. Cardiac magnetic resonance imaging was performed with late gadolinium enhancement and assessment of extracellular volume. Myocardial perfusion was assessed qualitatively and semiquantitatively using the myocardial-perfusion reserve index. Main Outcomes and Measures: The prevalence of obstructive epicardial CAD, CMD, and myocardial ischemia, infarction, and fibrosis. Results: Of 106 participants enrolled (53 [50%] women; mean [SD] age, 72 [9] years), 75 had coronary angiography, 62 had assessment of coronary microvascular function, 41 underwent coronary vasoreactivity testing, and 52 received cardiac magnetic resonance imaging. Obstructive epicardial CAD was present in 38 of 75 participants (51%, 95% CI, 39%-62%); 19 of 38 (50%; 95% CI, 34%-66%) had no history of CAD. Endothelium-independent CMD (ie, coronary flow reserve <2.0 and/or index of microvascular resistance ≥25) was identified in 41 of 62 participants (66%; 95% CI, 53%-77%). Endothelium-dependent CMD (ie, abnormal coronary vasoreactivity) was identified in 10 of 41 participants (24%; 95% CI, 13%-40%). Overall, 45 of 53 participants (85%; 95% CI, 72%-92%) had evidence of CMD and 29 of 36 (81%; 95% CI, 64%-91%) of those without obstructive epicardial CAD had CMD. Cardiac magnetic resonance imaging findings included myocardial-perfusion reserve index less than or equal to 1.84 (ie, impaired global myocardial perfusion) in 29 of 41 patients (71%; 95% CI, 54%-83%), visual perfusion defect in 14 of 46 patients (30%; 95% CI, 19%-46%), ischemic late gadolinium enhancement (ie, myocardial infarction) in 14 of 52 patients (27%; 95% CI, 16%-41%), and extracellular volume greater than 30% (ie, diffuse myocardial fibrosis) in 20 of 48 patients (42%; 95% CI, 28%-56%). Patients with obstructive CAD had more adverse events during follow-up (28 [74%]) than those without obstructive CAD (17 [46%]). Conclusions and Relevance: In this cohort study, 91% of patients with HFpEF had evidence of epicardial CAD, CMD, or both. Of those without obstructive CAD, 81% had CMD. Obstructive epicardial CAD and CMD appear to be common and often unrecognized in hospitalized patients with HFpEF and may be therapeutic targets.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Ford, Thomas and Rocchiccioli, Dr John and McEntegart, Dr Margaret and Jhund, Professor Pardeep and Petrie, Professor Mark and Lang, Professor Ninian and Oldroyd, Dr Keith and Campbell, Dr Ross and McMurray, Professor John and Sidik, Ms Novalia and Rush, Dr Christopher and Touyz, Professor Rhian
Authors: Rush, C. J., Berry, C., Oldroyd, K. G., Rocchiccioli, J. P., Lindsay, M. M., Touyz, R. M., Murphy, C. L., Ford, T. J., Sidik, N., McEntegart, M. B., Lang, N. N., Jhund, P. S., Campbell, R. T., McMurray, J. J.V., and Petrie, M. C.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:JAMA Cardiology
Publisher:American Medical Association
ISSN (Online):2380-6591
Published Online:23 June 2021

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
173501Coronary Artery Disease in Heart Failure with Preserved Ejection FractionJohn McMurrayOffice of the Chief Scientific Adviser (CSO)TCS/16/25Institute of Cardiovascular & Medical Sciences