Coronary microvascular dysfunction (CMD) was found to be independently associated with hospitalization for heart failure (HF) and cardiovascular death in patients with chronic stable HF with preserved ejection fraction (HFpEF), according to the results of a prospective observational study published in the Journal of Cardiac Failure.

A total of 257 patients with HFpEF with left ventricle ejection fraction ³40%, increased N-terminal pro B-type natriuretic peptide levels, a recent hospitalization due to HF, or increased filling pressures were recruited. Patients were assessed at baseline and 1 year (via a phone call) using the Kansas City Cardiomyopathy Questionnaire.

In this cohort, 57% were women, 83% had hypertension, 29% had diabetes mellitus, and medians were the following: age, 75 years (interquartile range [IQR], 70-81 years); heart rate, 68 beats/min (IQR, 60-78); systolic blood pressure, 139 mmHg (IQR, 125-152); and diastolic blood pressure, 76.5 mmHg (IQR, 68-85).

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CMD was observed in 75% of patients. Patients with vs without CMD were more likely to be smokers (70% vs 43%, respectively; P <.001), to have atrial fibrillation (58% vs 35%, respectively; P =.006), lower body mass indexes (median, 27 vs 29 kg/m2, respectively; P =.050), greater global left ventricular strain (median, 16 vs 18, respectively; P =.018), greater left atrial reservoir strain (median, 12 vs 20, respectively; P =.001), higher N-terminal pro B-type natriuretic peptide levels (median, 1050 vs 597 pg/mL, respectively; P =.006), and greater albumin to creatinine ratios (median, 3.6 vs 2.4, respectively; P =.0491).

Of 150 patients with CMD, 15 required hospitalization due to HF, 4 of whom died. Risk for hospitalization or death was significantly higher among patients with vs without CMD (P =.023) even after stratifying for cofactors that included age (P =.026), gender (P =.025), macrovascular coronary artery disease (P =.025), diabetes mellitus (P =.025), atrial fibrillation (P =.036), body mass index (P =.033), median N-terminal pro B-type natriuretic peptide level (P =.039), and estimated glomerular filtration rate (P =.022).

Quality of life assessment was comparable between baseline and the 1-year assessment in both groups (CMD: 69 vs 66, respectively; P =.825; no CMD: 68 vs 74, respectively; P =.280).

Study limitations include the fact that it was an analysis of data collected for the PRevalence Of MIcrovascular dySfunction in Heart Failure with Preserved Ejection Fraction (PROMIS-HFpEF) study, which was designed to evaluate the prevalence of CMD among patients with HFpEF, not to assess patient outcomes.

“The high prevalence of CMD and its CV and HF specific prognostic role suggest CMD may be a potential treatment target in HFpEF,” concluded the study authors.


Hage C, Svedlund S, Saraste A, et al. Association of coronary microvascular dysfunction with heart failure hospitalizations and mortality in heart failure with preserved ejection fraction – a follow-up in the PROMIS-HFpEF study. J Card Fail. 2020;S1071-9164(20)30916-7. doi:10.1016/cardfail.2020.08.010