Journal
EUROPEAN JOURNAL OF HEART FAILURE
Volume 23, Issue 5, Pages 765-772Publisher
WILEY
DOI: 10.1002/ejhf.2010
Keywords
Heart failure with preserved ejection fraction; Microvascular dysfunction; Exercise haemodynamics
Categories
Funding
- Mayo institutional funding
- Belgian American Educational Foundation (B.A.E.F.)
- Special Research Fund (BOF) of Hasselt University [BOF19PD04]
- [RO1 HL128526]
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This study found that coronary microvascular function is inversely associated with filling pressures, particularly during exercise. Both types of coronary microvascular dysfunction are associated with higher filling pressures at peak exercise.
Aims This study uniquely explored the relationship between coronary microvascular function and exercise haemodynamics using concurrent invasive testing. Methods and results Fifty-one consecutive patients with unexplained cardiac exertion symptoms, non-obstructive coronary artery disease and normal left ventricular ejection fraction (>50%) underwent haemodynamic exercise assessment and concurrent coronary reactivity testing. Heart failure with preserved ejection fraction (HFpEF) was defined as a pulmonary arterial wedge pressure (PAWP) >= 15 mmHg at rest and/or >= 25 mmHg at peak exercise. Endothelium-independent coronary microvascular dysfunction (CMD) was defined as a coronary flow reserve (CFR) <= 2.5, while endothelium-dependent CMD was defined as <= 50% increase in coronary blood flow (CBF) in response to intracoronary acetylcholine infusions. Patients with HFpEF (n= 22) had significantly lower CFR (2.5 +/- 0.6 vs. 3.2 +/- 0.7;P= 0.0003) and median %CBF increase in response to intracoronary acetylcholine [1 (-35; 34) vs. 64 (-4; 133);P= 0.002] compared to patients without HFpEF (n= 29). PAWP was significantly higher in patients with endothelium-independent CMD compared to controls during both rest and exercise. This significant elevation was only present during exercise in patients with endothelium-dependent CMD compared to controls. CFR had significant inverse correlations with PAWP at rest (r = -0.31;P= 0.03) and peak exercise (r = -0.47,P= 0.001). CFR also had positive correlations with maximal exercise capacity (in W/kg) (r = 0.33,P= 0.02). Conclusions Coronary microvascular function is inversely associated with filling pressures, particularly during exercise. Both types of CMD are associated with higher filling pressures at peak exercise. These findings underscore the potential mechanism and therapeutic target for CMD and HFpEF.
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