Physicians' Academy for Cardiovascular Education

High prevalence of coronary microvascular dysfunction in patients with HFpEF

Literature - Shah SJ, Lam CSP, Svedlund S et al. - Eur Heart J 2018; published online ahead of print

Introduction and methods

Preclinical data suggest that coronary microvascular dysfunction (CMD) contributes to the development of heart failure with preserved ejection fraction (HFpEF), through various mechanisms including the reduction of endothelial nitric oxide bioavailability and cyclic guanosine monophosphate production, resulting in increased cardiomyocyte stiffening, hypertrophy, and fibrosis [1-3]. Clinical evidence supporting this hypothesis, is, however, scarce, and the prevalence of CMD in HFpEF is unknown.

The prospective PROMIS-HFpEF (PRevalence Of Microvascular dySfunction in Heart Failure with Preserved Ejection Fraction) study assessed the prevalence of impaired coronary flow reserve (CFR) in HFpEF, and explored possible correlates, such as systemic endothelial dysfunction (reactive hyperemia index: RHI, urinary albumin-to-creatinine ratio: UACR), clinical factors, laboratory markers, and echocardiographic indices. For this purpose, detailed echocardiography and adenosine-based transthoracic Doppler echocardiography-assessed CFR measurements were combined in HFpEF patients. CMD was defined as a coronary flow velocity ratio of <2.5 [4].

Eligible patients had a prior history of symptomatic HF, NYHA Class II–IV symptoms, an EF ≥40%, and at least one of the following:

Patients with known unrevascularized macrovascular coronary artery disease were excluded.

Main results


Impaired coronary microvascular function is highly prevalent in HFpEF patients and is associated with systemic endothelial dysfunction, as well as with markers of HF severity such as elevated NTproBNP and cardiac dysfunction.


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Find this article online at Eur Heart J

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