Abstract
Background
Coronary microvascular dysfunction (CMD) is common in heart failure with preserved
ejection fraction (HFpEF). We assessed the association of CMD with hospitalization
and mortality in HFpEF.
Methods and Results
We assessed the 1-year outcomes in patients from the PROMIS-HFpEF study, a prospective
observational study of patients with chronic stable HFpEF undergoing coronary flow
reserve measurements. Outcomes were (1) time to cardiovascular (CV) death/first HF
hospitalization, (2) CV death/recurrent HF hospitalizations, (3) all-cause death/first
HF hospitalization, and (4) first and (5) recurrent all-cause hospitalizations. CMD
was defined as coronary flow reserve of <2.5. Time to CV death/first hospitalization
was compared by log-rank test and recurrent HF and all-cause hospitalizations by Poisson
test. Of 263 patients enrolled, 257 were evaluable at 1 year. Where the coronary flow
reserve was interpretable (n = 201), CMD was present in 150 (75%). The median follow-up was 388 days (Q1, Q3 365,
418). The outcome of CV death/first HF hospitalization occurred in 15 patients (4
CV deaths). The incidence rate was in CMD 96 per 1000 person-years, 95% confidence
interval 54–159, vs non-CMD 0 per1000 person-years, 95% confidence interval 0–68,
P = .023, and remained significant after accounting for selected clinical variables.
In patients with CMD, the incidence rates were significantly higher also for CV death/recurrent
HF hospitalizations, all-cause death/first HF, and recurrent but not first all-cause
hospitalization.
Conclusions
In this exploratory assessment of the prognostic role of CMD in HFpEF, CMD was independently
associated with primarily CV- and HF-specific events. The high prevalence of CMD and
its CV and HF specific prognostic role suggest CMD may be a potential treatment target
in HFpEF.
Key Words
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Article info
Publication history
Published online: August 23, 2020
Accepted:
August 19,
2020
Received in revised form:
August 4,
2020
Received:
June 26,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
