Coronary Microvascular Dysfunction and Future HF Risk

Study Questions:

What is the relationship between coronary flow reserve (CFR), myocardial injury, diastolic dysfunction, and future heart failure with preserved ejection fraction (HFpEF) risk?

Methods:

The study cohort was comprised of 201 consecutive patients who did not have flow-limiting coronary artery disease (CAD) or reduced left ventricular ejection fraction. They were identified from a group of patients undergoing evaluation for suspected CAD with stress myocardial perfusion positron emission tomography, serum troponin, and transthoracic echocardiography. The median follow-up period was 4.1 years, during which cardiovascular outcomes (including cardiovascular death and hospitalization for nonfatal myocardial infarction or HF) were identified. The study authors quantified CFR as stress/rest myocardial blood flow. Early diastolic flow (E) and relaxation (e’) velocities were obtained by transmitral and tissue Doppler, respectively.

Results:

The study investigators found that patients with impaired CFR (<2, n = 108) demonstrated linearly decreasing e’ and increasing E/e’ consistent with worsening diastolic function (p for trend < 0.0001). A detectable troponin was associated with diastolic dysfunction only in the presence of impaired CFR (interaction p = 0.002). In adjusted analyses, impaired CFR was independently associated with diastolic dysfunction (E/e’septal > 15, adjusted odds ratio, 2.58; 95% confidence interval [CI], 1.22–5.48) and composite cardiovascular outcomes or HFpEF hospitalization alone (adjusted hazard rato, 2.47; 95% CI, 1.09-5.62). Patients with both impaired CFR and diastolic dysfunction demonstrated > five-fold increased risk of HFpEF hospitalization (p < 0.001).

Conclusions:

The authors concluded that in symptomatic patients without overt CAD, impaired CFR was independently associated with diastolic dysfunction and adverse events, especially HFpEF hospitalization.

Perspective:

This is an important study because it suggests that a panel of biomarkers can better predict HF hospitalizations. It would be interesting to confirm these findings prospectively in a large cohort, particularly with a combination of cardiac troponin and Doppler echocardiography parameters of diastolic dysfunction.

Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Acute Heart Failure, Chronic Heart Failure, Heart Failure and Cardiac Biomarkers, Computed Tomography, Echocardiography/Ultrasound, Nuclear Imaging

Keywords: Biological Markers, Coronary Artery Disease, Diagnostic Imaging, Diastole, Echocardiography, Echocardiography, Doppler, Heart Failure, Heart Failure, Diastolic, Myocardial Infarction, Myocardial Reperfusion Injury, Positron-Emission Tomography, Risk, Stroke Volume, Troponin, Ventricular Dysfunction


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