Nordberg Backelin Charlotte, Svedlund Sara, Bollano Entela, Hjalmarsson Clara, Gupta Akash Kumar, Dahllöf Karl Johan, Wolfhagen Sand Fredrik, Fermer Maria Lagerström, Michaelsson Erik, Moss Alastair, Silfversparre Ida, Brodin Tove, Pirazzi Carlo, Lund Lars, Hage Camilla, Ljungman Charlotta
Cardiology Department, Sahlgrenska University Hospital, Gothenburg, Sweden
Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Open Heart. 2025 Sep 5;12(2):e003509. doi: 10.1136/openhrt-2025-003509.
We investigated the prevalence of coronary microvascular dysfunction (CMD) and its association with severity of heart failure in patients with reduced or mildly reduced ejection fraction (HFrEF and HFmrEF).
Patients with stable, symptomatic heart failure with left ventricular ejection fraction (LVEF) <50% were enrolled. Data collection included physical examination, blood samples, Kansas City Cardiomyopathy Questionnaire (KCCQ), carotid to femoral pulse wave velocity, echocardiography and adenosine-based transthoracic Doppler echocardiography to assess coronary flow reserve (CFR). A CFR <2.5 was used to diagnose CMD. Adjusted multivariable linear regression analysis with CFR as the dependent variable and adjusted multivariate logistic regression with CMD as the dependent variable were performed.
A total of 125 patients were included, of whom 99 (79%) were men. The overall mean age is 73.4 (±7.5) years. In patients eligible for CFR (n=68, 54%), CMD was present in 45 (66%). Patients with CMD had higher N-terminal pro B-type natriuretic peptide (NTproBNP), hsTroponin-T, lower KCCQ score, lower left and right ventricular and left atrial global longitudinal strain (GLS) (p<0.05). In multivariable linear regression, lower CFR was independently associated with reduced GLS, higher NTproBNP and hsTroponin-T. Furthermore, in adjusted logistic regression analysis, lower LVEF, reduced right ventricular GLS and higher biomarkers were independently associated with an increased risk of CMD.
CMD was present in 66% of patients with chronic heart failure and HFrEF or HFmrEF. Markers of more severe heart failure, including reduced GLS and higher NTproBNP and hsTroponin-T, were independently associated with lower CFR. Reduced right ventricular GLS and higher levels of the biomarkers were also independently associated with CMD.
我们研究了射血分数降低或轻度降低的心力衰竭患者（HFrEF和HFmrEF）中冠状动脉微血管功能障碍（CMD）的患病率及其与心力衰竭严重程度的关系。
纳入左心室射血分数（LVEF）<50%的稳定、有症状心力衰竭患者。数据收集包括体格检查、血样、堪萨斯城心肌病问卷（KCCQ）、颈股脉搏波速度、超声心动图和基于腺苷的经胸多普勒超声心动图以评估冠状动脉血流储备（CFR）。CFR<2.5用于诊断CMD。进行以CFR为因变量的调整多变量线性回归分析和以CMD为因变量的调整多变量逻辑回归分析。
共纳入125例患者，其中99例（79%）为男性。总体平均年龄为73.4（±7.5）岁。在符合CFR评估条件的患者中（n=68，54%），45例（66%）存在CMD。CMD患者的N末端B型利钠肽原（NTproBNP）、高敏肌钙蛋白T水平较高，KCCQ评分较低，左、右心室及左心房整体纵向应变（GLS）较低（p<0.05）。在多变量线性回归中，较低的CFR与降低的GLS、较高的NTproBNP和高敏肌钙蛋白T独立相关。此外，在调整逻辑回归分析中，较低的LVEF、降低的右心室GLS和较高的生物标志物与CMD风险增加独立相关。
66%的慢性心力衰竭及HFrEF或HFmrEF患者存在CMD。更严重心力衰竭的标志物，包括降低的GLS和较高的NTproBNP及高敏肌钙蛋白T，与较低的CFR独立相关。降低的右心室GLS和较高水平的生物标志物也与CMD独立相关。
