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?


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.


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).


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


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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