The association of coronary microvascular dysfunction and cardiac maladaptation with clinical outcomes in heart failure with preserved ejection fraction: A prospective dynamic SPECT study.
Journal
International journal of cardiology
Journal Volume
425
ISSN
1874-1754
Date Issued
2025-04-15
Author(s)
Hung, Ta-Chuan
Chien, Shih-Chieh
Tsao, Chin-Ho
Yen, Chih-Hsuan
Hsiao, Chih-Chung
Lin, Hui-Chun
Tsai, Jui-Peng
Peng, Ming-Cheng
Tsai, Cheng-Ting
Hung, Chung-Lieh
DOI
10.1016/j.ijcard.2025.133064
Abstract
Background: Accumulating evidences have suggested a pathophysiological link between coronary microvascular dysfunction (CMD) and heart failure with preserved ejection fraction (HFpEF). The clinical relevance and prognostic impact of myocardial blood flow (MBF) using single-photon emission computed tomography (SPECT) among HFpEF patients remain unexplored clearly. Methods: Fifty-five patients with HFpEF and 48 controls were prospectively enrolled. All underwent dynamic myocardial perfusion imaging with (99 m) Tc-sestamibi at rest and a stress test at peak with dipyridamole. MBF and myocardial flow reserve (MFR) parameters were obtained after perfusion and further related to cardiac structural and advanced functional strain measures using echocardiography and clinical outcomes. Results: CMD (defined as global MFR <2.5) was more prevalent in HFpEF than in control (71 % vs 16.7 %). Patients with HFpEF had worse longitudinal strain indices, lower post-stress MBF (2.37 ± 0.78 vs. 3.30 ± 0.94 ml/min/g, p < 0.001), higher global rest MBF (1.11 ± 0.55 vs. 0.89 ± 0.19 ml/min/g, p = 0.008), and lower global MFR (2.34 ± 0.84 vs. 3.68 ± 1.04, p < 0.001) than the controls. These results were similar for the regional MFRs in the vascular-based analysis. Lower MFR correlated with more impaired left ventricular, left atrial, and right ventricular strain measures (r = −0.44, 0.38, and 0.27, respectively, all p < 0.05). Patients with HFpEF and CMD had increased risks of all-cause mortality and hospitalization compared with those without HFpEF nor CMD (adjusted hazard: 6.42, 95 % CI: 1.40–29.43, p = 0.017). Conclusions: CMD by dynamic SPECT is frequently observed among patients with HFpEF and correlated with more impaired overall cardiac mechanics. HFpEF with comorbid CMD had worse clinical outcome.
Subjects
Coronary microvascular dysfunction
Dynamic SPECT
Heart failure with preserved ejection fraction
Myocardial blood flow
Prognosis
Publisher
2-s2.0-85217771153
Description
Article number 133064
Type
journal article