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Coronary microvascular dysfunction and future risk of heart failure with preserved ejection fraction
European
heart
journal, 2018-03, Vol.39 (10), p.840-849
[Peer Reviewed Journal]
2018 ;ISSN: 0195-668X ;EISSN: 1522-9645 ;DOI: 10.1093/eurheartj/ehx721 ;PMID: 29293969
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Title:
Coronary microvascular dysfunction and future risk of heart failure with preserved ejection fraction
Author:
Taqueti, Viviany R
;
Solomon, Scott D
;
Shah, Amil M
;
Desai, Akshay S
;
Groarke, John D
;
Osborne, Michael T
;
Hainer, Jon
;
Bibbo, Courtney F
;
Dorbala, Sharmila
;
Blankstein, Ron
;
Di Carli, Marcelo F
Subjects:
Aged
;
Aged, 80 and over
;
Clinical Research
;
Coronary Artery Disease - complications
;
Coronary Artery Disease - epidemiology
;
Coronary Artery Disease - physiopathology
;
Editor's Choice
;
Female
;
Follow-Up Studies
;
Heart
Failure
, Diastolic - epidemiology
;
Heart
Failure
, Diastolic - etiology
;
Heart
Failure
, Diastolic - mortality
;
Heart
Failure
, Diastolic - physiopathology
;
Humans
;
Male
;
Middle Aged
;
Stroke Volume - physiology
;
Troponin - blood
Is Part Of:
European
heart
journal, 2018-03, Vol.39 (10), p.840-849
Description:
Abstract Aims Coronary microvascular ischaemia, cardiomyocyte injury and stiffness may play an important role in the pathophysiology of heart failure with preserved ejection fraction (HFpEF). To date, the relationship between coronary flow reserve (CFR), myocardial injury, diastolic dysfunction, and future HFpEF risk is unknown. Methods and results Consecutive patients (n = 201) undergoing evaluation for suspected coronary artery disease (CAD) with stress myocardial perfusion positron emission tomography, serum troponin, and transthoracic echocardiography who did not have flow-limiting CAD or reduced left ventricular ejection fraction were identified. Patients were followed up (median 4.1 years) for cardiovascular death and hospitalization for non-fatal myocardial infarction or heart failure. Coronary flow reserve was quantified as stress/rest myocardial blood flow. Early diastolic flow (E) and relaxation (e′) velocities were obtained via transmitral and tissue Doppler, respectively. 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 OR 2.58, 95%CI 1.22–5.48) and composite cardiovascular outcomes or HFpEF hospitalization alone (adjusted HR 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). Conclusion In symptomatic patients without overt CAD, impaired CFR was independently associated with diastolic dysfunction and adverse events, especially HFpEF hospitalization. The presence of both coronary microvascular and diastolic dysfunctions was associated with a markedly increased risk of HFpEF events.
Publisher:
England: Oxford University Press
Language:
English
Identifier:
ISSN: 0195-668X
EISSN: 1522-9645
DOI: 10.1093/eurheartj/ehx721
PMID: 29293969
Source:
GFMER Free Medical Journals
MEDLINE
Alma/SFX Local Collection
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