The Library
Prevalence and prognostic significance of microvascular dysfunction in heart failure With preserved ejection fraction
Tools
Arnold, J. Ranjit, Kanagala, Prathap, Budgeon, Charley A., Jerosch-Herold, Michael, Gulsin, Gaurav S., Singh, Anvesha, Khan, Jamal Nasir, Chan, Daniel C.S., Squire, Iain B., Ng, Leong L. and McCann, Gerry P. (2022) Prevalence and prognostic significance of microvascular dysfunction in heart failure With preserved ejection fraction. JACC: Cardiovascular Imaging, 15 (6). pp. 1001-1011. doi:10.1016/j.jcmg.2021.11.022 ISSN 1936878X.
Research output not available from this repository.
Request-a-Copy directly from author or use local Library Get it For Me service.
Official URL: https://doi.org/10.1016/j.jcmg.2021.11.022
Abstract
Background:
The pathophysiological and clinical significance of microvascular dysfunction (MVD) in patients with heart failure with preserved ejection fraction (HFpEF) remains uncertain.
Objectives
The aim of this study was to use cardiovascular magnetic resonance to: 1) quantify coronary microvascular function; 2) examine the relationship between perfusion and fibrosis; and 3) evaluate the impact of MVD and fibrosis on long-term clinical outcomes.
Methods:
In a prospective, observational study, patients with HFpEF and control subjects underwent multiparametric cardiovascular magnetic resonance (comprising assessment of left ventricular volumetry, perfusion, and fibrosis [focal by late gadolinium enhancement and diffuse by extracellular volume]). The primary endpoint was the composite of death or hospitalization with heart failure.
Results:
One hundred and one patients with HFpEF (mean age 73 ± 9 years, mean ejection fraction 56% ± 5%) and 43 control subjects (mean age 73 ± 5 years, mean ejection fraction 58% ± 5%) were studied. Myocardial perfusion reserve (MPR) was lower in patients with HFpEF versus control subjects (1.74 ± 0.76 vs 2.22 ± 0.76; P = 0.001). MVD (defined as MPR <2.0) was present in 70% of patients with HFpEF (vs 48% of control subjects; P = 0.014). There was no significant linear correlation between MPR and diffuse fibrosis (r = −0.10; P = 0.473) and no difference in MPR between those with and without focal fibrosis (mean difference −0.03; 95% CI: −0.37 to 0.30). In the HFpEF group, during median follow-up of 3.1 years, there were 45 composite events. MPR was independently predictive of clinical outcome following adjustment for clinical, blood, and imaging parameters (1 SD increase: HR: 0.673 [95% CI: 0.463 to 0.978; P = 0.038]; HR: 0.694 [95% CI: 0.491 to 0.982; P = 0.039]; and HR: 0.690 [95% CI: 0.489 to 0.973; P = 0.034], respectively).
Conclusions:
MVD is highly prevalent among patients with HFpEF and is an independent predictor of prognosis. The lack of correlation between MVD and fibrosis may challenge the assertion of a direct causal link between these entities. (Developing Imaging and Plasma Biomarkers in Describing Heart Failure With Preserved Ejection Fraction [DIAMONDHFpEF]; NCT03050593)
Item Type: | Journal Article | ||||||||
---|---|---|---|---|---|---|---|---|---|
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
||||||||
SWORD Depositor: | Library Publications Router | ||||||||
Journal or Publication Title: | JACC: Cardiovascular Imaging | ||||||||
Publisher: | Elsevier | ||||||||
ISSN: | 1936878X | ||||||||
Official Date: | 6 June 2022 | ||||||||
Dates: |
|
||||||||
Volume: | 15 | ||||||||
Number: | 6 | ||||||||
Page Range: | pp. 1001-1011 | ||||||||
DOI: | 10.1016/j.jcmg.2021.11.022 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Restricted or Subscription Access |
Request changes or add full text files to a record
Repository staff actions (login required)
View Item |