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Prevalence and correlates of coronary microvascular dysfunction in heart failure with preserved ejection fraction: PROMIS-HFpEF

Artikel i vetenskaplig tidskrift
Författare S. J. Shah
C. S. P. Lam
Sara Svedlund
A. Saraste
C. Hage
R. S. Tan
L. Beussink-Nelson
M. L. Fermer
Li-Ming Gan
L. H. Lund
Publicerad i European Heart Journal
Volym 39
Nummer/häfte 37
Sidor 3439-3450
ISSN 0195-668X
Publiceringsår 2018
Publicerad vid Institutionen för medicin
Institutionen för medicin, avdelningen för molekylär och klinisk medicin
Sidor 3439-3450
Språk en
Länkar dx.doi.org/10.1093/eurheartj/ehy531
Ämnesord Heart failure with preserved ejection fraction, Coronary microvascular dysfunction, Coronary flow, ventricular diastolic function, endothelial dysfunction, european-association, american-society, echocardiography, reserve, recommendations, guidelines, albuminuria, cardiology
Ämneskategorier Kardiologi

Sammanfattning

Aims To date, clinical evidence of microvascular dysfunction in patients with heart failure (HF) with preserved ejection fraction (HFpEF) has been limited. We aimed to investigate the prevalence of coronary microvascular dysfunction (CMD) and its association with systemic endothelial dysfunction, HF severity, and myocardial dysfunction in a well defined, multi-centre HFpEF population. Methods and results This prospective multinational multi-centre observational study enrolled patients fulfilling strict criteria for HFpEF according to current guidelines. Those with known unrevascularized macrovascular coronary artery disease (CAD) were excluded. Coronary flow reserve (CFR) was measured with adenosine stress transthoracic Doppler echocardiography. Systemic endothelial function [reactive hyperaemia index (RHI)] was measured by peripheral arterial tonometry. Among 202 patients with HFpEF, 151 [75% (95% confidence interval 69-81%)] had CMD (defined as CFR < 2.5). Patients with CMD had a higher prevalence of current or prior smoking (70% vs. 43%; P = 0.0006) and atrial fibrillation (58% vs. 25%; P = 0.004) compared with those without CMD. Worse CFR was associated with higher urinary albumin-to-creatinine ratio (UACR) and NTproBNP, and lower RHI, tricuspid annular plane systolic excursion, and right ventricular (RV) free wall strain after adjustment for age, sex, body mass index, atrial fibrillation, diabetes, revascularized CAD, smoking, left ventricular mass, and study site (P < 0.05 for all associations). Conclusions PROMIS-HFpEF is the first prospective multi-centre, multinational study to demonstrate a high prevalence of CMD in HFpEF in the absence of unrevascularized macrovascular CAD, and to show its association with systemic endothelial dysfunction (RHI, UACR) as well as markers of HF severity (NTproBNP and RV dysfunction). Microvascular dysfunction may be a promising therapeutic target in HFpEF.

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