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Microvascular dysfunction is associated with impaired cardiac function in patients with and without preserved ejection fraction heart failure

https://doi.org/10.1007/s00392-025-02625-4

Ornela Velollari (Mainz)1, A. Biancofiore (Grosseto)2, M. Olschweski (Mainz)1, H. Ullrich-Daub (Mainz)1, T. Münzel (Mainz)1, K.-P. Rommel (Mainz)1, P. Lurz (Mainz)1, T. Gori (Mainz)1, K.-P. Kresoja (Mainz)1

1Universitätsmedizin der Johannes Gutenberg-Universität Mainz Kardiologie 1, Zentrum für Kardiologie Mainz, Deutschland; 2Misericordia Hospital, Azienda USL (Unità Sanitaria Locale) Department of Interventional Cardiology Grosseto, Italien

 

Aims: The relationship between coronary microvascular dysfunction (CMD) and heart failure with preserved ejection fraction (HFpEF) is incompletely understood. Therefore, this study aimed to investigate the association between CMD and markers of left ventricular systolic and diastolic function.

Methods: Patients with symptoms of angina (CCS II-IV) and without significant epicardial stenosis underwent measurement of coronary vasomotor function and were enrolled in a prospective registry. Left ventricular global longitudinal strain (GLS), left atrial reservoir strain (LARS) and E/E’ were assessed on echocardiography. Additionally, echocardiographic single-beat estimations of the end-diastolic pressure-volume relationship (LVEDPVR) were constructed and integrated in a single diastolic marker - left ventricular volume at a given end-diastolic pressure of 10 mmHg (LV-VPED10mmHg). CMD was defined as a reduced coronary flow reserve (CFR)<2.5 or elevated microvascular resistance (IMR)≥25. HFpEF was diagnosed according to the 2016 ESC Guidelines on heart failure.

Results: 76 (49 %) of the 154 subjects had CMD. HFpEF was more prevalent in these patients as compared to patients without CMD (39% vs. 20%, p=0.027).  In the overall cohort, CMD was associated with reduced GLS (p<0.001) and LARS (p<0.004), lower LV-VPED10mmHg – indicating worse diastolic function – and accordingly elevated E/E’ (p<0.001) (Figure 1: A-D).

Patients with HFpEF and CMD exhibited an impairment in markers of systolic (GLS) and diastolic (LV-VPED10mmHg) left ventricular function. These changes were not present in patients fulfilling HFpEF criteria without CMD. (Figure 1: G).E/E´ and left atrial reservoir strain were abnormal in all groups with HFpEF and/or CMD.

Conclusion: CMD and HFpEF are frequently co-existing cardiac alterations. In HFpEF patients, the coexistence of CMD is associated with worse systolic and diastolic function. Importantly, even in the absence of clinical HFpEF, CMD adversely affects cardiac systolic and diastolic function, suggesting that CMD might precede the development of an HFpEF phenotype.

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