Cardiovascular Center Aalst, OLV Hospital, Belgium (P.P., E.G., M.B., D.T.B., K.B., C.D.C., M.S., A.L., G.E., D.F., A.M., L.D., M.P., B.D.B., J.B., M.V.).
Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (P.P., M.B., D.T.B., C.D.C., A.L., G.E., D.F.).
Circ Heart Fail. 2024 Jan;17(1):e010805. doi: 10.1161/CIRCHEARTFAILURE.123.010805. Epub 2023 Dec 18.
Coronary microvascular dysfunction (CMD) is involved in heart failure (HF) onset and progression, independently of HF phenotype and obstructive coronary artery disease. Invasive assessment of CMD might provide insights into phenotyping and prognosis of patients with HF. We aimed to assess absolute coronary flow, absolute microvascular resistance, myocardial perfusion, coronary flow reserve, and microvascular resistance reserve in patients with HF with preserved ejection fraction and HF with reduced ejection fraction (HFrEF).
Single-center, prospective study of 56 consecutive patients with de novo HF with nonobstructive coronary artery disease divided into HF with preserved ejection fraction (n=21) and HFrEF (n=35). CMD was invasively assessed by continuous intracoronary thermodilution and defined as coronary flow reserve <2.5. Left ventricular and left anterior descending artery-related myocardial mass was quantified by echocardiography and coronary computed tomography angiography. Myocardial perfusion (mL/min per g) was calculated as the ratio between absolute coronary flow and left anterior descending artery-related mass.
Patients with HFrEF showed a higher left ventricular and left anterior descending artery-related myocardial mass compared with HF with preserved ejection fraction (<0.010). Overall, 52% of the study population had CMD, with a similar prevalence between the 2 groups. In HFrEF, CMD was characterized by lower absolute microvascular resistance and higher absolute coronary flow at rest (functional CMD; =0.002). CMD was an independent predictor of a lower rate of left ventricular reverse remodeling at follow-up. In patients with HF with preserved ejection fraction, CMD was mainly due to higher absolute microvascular resistance and lower absolute coronary flow during hyperemia (structural CMD; ≤0.030).
Continuous intracoronary thermodilution allows the definition and characterization of patterns with distinct CMD in patients with HF and could identify patients with HFrEF with a higher rate of left ventricular reverse remodeling at follow-up.
冠状动脉微血管功能障碍（CMD）与心力衰竭（HF）的发生和进展有关，与 HF 表型和阻塞性冠状动脉疾病无关。CMD 的侵入性评估可能有助于了解 HF 患者的表型和预后。我们旨在评估射血分数保留的心力衰竭（HFpEF）和射血分数降低的心力衰竭（HFrEF）患者的绝对冠状动脉血流、绝对微血管阻力、心肌灌注、冠状动脉血流储备和微血管阻力储备。
对 56 例新发非阻塞性冠状动脉疾病的 HF 患者进行单中心前瞻性研究，分为 HFpEF（n=21）和 HFrEF（n=35）。通过连续冠状动脉内热稀释法评估 CMD，并将冠状动脉血流储备<2.5 定义为 CMD。通过超声心动图和冠状动脉计算机断层血管造影术定量评估左心室和左前降支相关心肌质量。心肌灌注（mL/min/g）计算为绝对冠状动脉血流与左前降支相关质量的比值。
与 HFpEF 相比，HFrEF 患者的左心室和左前降支相关心肌质量更高（<0.010）。总的来说，52%的研究人群存在 CMD，两组之间的患病率相似。在 HFrEF 中，CMD 表现为静息时较低的绝对微血管阻力和较高的绝对冠状动脉血流（功能性 CMD；=0.002）。CMD 是随访时左心室反向重构率较低的独立预测因素。在 HFpEF 患者中，CMD 主要是由于充血时绝对微血管阻力较高和绝对冠状动脉血流较低（结构性 CMD；≤0.030）。
连续冠状动脉内热稀释法可定义和描述 HF 患者中不同类型的 CMD，并可识别随访时左心室反向重构率较高的 HFrEF 患者。
