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Myocardial Injury and Cardiac Reserve in Patients With Heart Failure and Preserved Ejection Fraction

Obokata, Masaru, Reddy, Yogesh N.V., Melenovsky, Vojtech, Kane, Garvan C., Olson, Thomas P., Jarolim, Petr, Borlaug, Barry A.·2018·Journal of the American College of Cardiology
DOI 10.1016/j.jacc.2018.04.039PMC PMC6034112
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  • Patients with HFpEF frequently display chronic low-grade myocardial injury as reflected by elevated levels of troponin, and this degree of myocardial injury is correlated with severity of cardiac dysfunction, hemodynamic congestion, impairment in functional capacity and risk for HF hospitalization.

    “Patients with HFpEF also frequently display chronic low-grade myocardial injury as reflected by elevated levels of troponin13,14, and like albuminuria, this degree of myocardial injury in HFpEF is correlated with the severity of cardiac dysfunction, hemodynamic congestion, impairment in functional capacity and risk for HF hospitalization13,14.”

    From Effects of tirzepatide on circulatory overload and end-organ damage in heart failure with preserved ejection fraction and obesity: a secondary analysis of the SUMMIT trial (2025) · cites this paper as [13]

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  • The low-grade myocardial injury in HFpEF as observed at baseline in SUMMIT is believed to be related to cardiomyocyte loss due to repetitive elevations in cardiac filling pressures during stress, along with adverse loading conditions caused by ventricular-vascular stiffening.

    “The low-grade myocardial injury in HFpEF as observed at baseline in SUMMIT is believed to be related to cardiomyocyte loss due to repetitive elevations in cardiac filling pressures during stress, along with adverse loading conditions caused by ventricular–vascular stiffening13,34.”

    From Effects of tirzepatide on circulatory overload and end-organ damage in heart failure with preserved ejection fraction and obesity: a secondary analysis of the SUMMIT trial (2025) · cites this paper as [13]

  • Patients with HFpEF and elevated troponin have more severe elevation in filling pressures, reduced myocardial stress reserve and poorer exercise capacity compared with those without injury.

    “Patients with HFpEF and elevated troponin have more severe elevation in filling pressures, reduced myocardial stress reserve and poorer exercise capacity compared with those without injury13, and individuals with the obesity phenotype have higher troponin levels than those without obesity15.”

    From Effects of tirzepatide on circulatory overload and end-organ damage in heart failure with preserved ejection fraction and obesity: a secondary analysis of the SUMMIT trial (2025) · cites this paper as [13]

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Research works printed but not linked: 36

  1. Shah, 2016, Phenotype-specific treatment of heart failure with preserved ejection fraction: a multiorgan roadmap, Circulation, 134, 73, 10.1161/CIRCULATIONAHA.116.021884 · DOI · Paper page
  2. Borlaug, 2006, Impaired chronotropic and vasodilator reserves limit exercise capacity in patients with heart failure and a preserved ejection fraction, Circulation, 114, 2138, 10.1161/CIRCULATIONAHA.106.632745 · DOI · Paper page
  3. Tan, 2009, The pathophysiology of heart failure with normal ejection fraction: exercise echocardiography reveals complex abnormalities of both systolic and diastolic ventricular function involving torsion, untwist, and longitudinal motion, J Am Coll Cardiol, 54, 36, 10.1016/j.jacc.2009.03.037 · DOI
  4. Phan, 2009, Heart failure with preserved ejection fraction is characterized by dynamic impairment of active relaxation and contraction of the left ventricle on exercise and associated with myocardial energy deficiency, J Am Coll Cardiol, 54, 402, 10.1016/j.jacc.2009.05.012 · DOI
  5. Borlaug, 2010, Exercise hemodynamics enhance diagnosis of early heart failure with preserved ejection fraction, Circ Heart Fail, 3, 588, 10.1161/CIRCHEARTFAILURE.109.930701 · DOI
  6. Borlaug, 2011, Diastolic relaxation and compliance reserve during dynamic exercise in heart failure with preserved ejection fraction, Heart, 97, 964, 10.1136/hrt.2010.212787 · DOI · Paper page
  7. Borlaug, 2016, Abnormal right ventricular-pulmonary artery coupling with exercise in heart failure with preserved ejection fraction, Eur Heart J, 37, 3293, 10.1093/eurheartj/ehw241 · DOI
  8. Borlaug, 2010, Global cardiovascular reserve dysfunction in heart failure with preserved ejection fraction, J Am Coll Cardiol, 56, 845, 10.1016/j.jacc.2010.03.077 · DOI
  9. Abudiab, 2013, Cardiac output response to exercise in relation to metabolic demand in heart failure with preserved ejection fraction, Eur J Heart Fail, 15, 776, 10.1093/eurjhf/hft026 · DOI
  10. Kosmala, 2016, Contributions of nondiastolic factors to exercise intolerance in heart failure with preserved ejection fraction, J Am Coll Cardiol, 67, 659, 10.1016/j.jacc.2015.10.096 · DOI
  11. Kosmala, 2017, Association of abnormal left ventricular functional reserve with outcome in heart failure with preserved ejection fraction, J Am Coll Cardiol Img
  12. Maeder, 2010, Hemodynamic basis of exercise limitation in patients with heart failure and normal ejection fraction, J Am Coll Cardiol, 56, 855, 10.1016/j.jacc.2010.04.040 · DOI
  13. van Empel, 2014, Impaired myocardial oxygen availability contributes to abnormal exercise hemodynamics in heart failure with preserved ejection fraction, J Am Heart Assoc, 3, e001293, 10.1161/JAHA.114.001293 · DOI
  14. Dorfs, 2014, Pulmonary capillary wedge pressure during exercise and long-term mortality in patients with suspected heart failure with preserved ejection fraction, Eur Heart J, 35, 3103, 10.1093/eurheartj/ehu315 · DOI
  15. Franssen, 2016, Myocardial microvascular inflammatory endothelial activation in heart failure with preserved ejection fraction, Jam Coll Cardiol Heart Fail, 4, 312
  16. Kato, 2016, Impairment of coronary flow reserve evaluated by phase contrast cine-magnetic resonance imaging in patients with heart failure with preserved ejection fraction, J Am Heart Assoc, 5, e002649, 10.1161/JAHA.115.002649 · DOI
  17. Srivaratharajah, 2016, Reduced myocardial flow in heart failure patients with preserved ejection fraction, Circ Heart Fail, 9, e002562, 10.1161/CIRCHEARTFAILURE.115.002562 · DOI
  18. Mohammed, 2016, Zooming in on the microvasculature in heart failure with preserved ejection fraction, Circ Heart Fail, 9, e003272, 10.1161/CIRCHEARTFAILURE.116.003272 · DOI
  19. Saiki, 2017, Risk of heart failure with preserved ejection fraction in older women after contemporary radiotherapy for breast cancer, Circulation, 135, 1388, 10.1161/CIRCULATIONAHA.116.025434 · DOI
  20. Tschope, 2005, High prevalence of cardiac parvovirus B19 infection in patients with isolated left ventricular diastolic dysfunction, Circulation, 111, 879, 10.1161/01.CIR.0000155615.68924.B3 · DOI
  21. Tschope, 2015, Latent ischaemia as a trigger for a circulus vitiosus of inflammation, fibrosis, and stiffness in HFPEF, Eur J Heart Fail, 17, 1210, 10.1002/ejhf.439 · DOI
  22. Andersen, 2015, Differential hemodynamic effects of exercise and volume expansion in people with and without heart failure, Circ Heart Fail, 8, 41, 10.1161/CIRCHEARTFAILURE.114.001731 · DOI
  23. Andersen, 2015, Enhanced pulmonary vasodilator reserve and abnormal right ventricular: pulmonary artery coupling in heart failure with preserved ejection fraction, Circ Heart Fail, 8, 542, 10.1161/CIRCHEARTFAILURE.114.002114 · DOI
  24. Reddy, 2017, Arterial stiffening with exercise in patients with heart failure and preserved ejection fraction, J Am Coll Cardiol, 70, 136, 10.1016/j.jacc.2017.05.029 · DOI · Paper page
  25. Buckberg, 1972, Experimental subendocardial ischemia in dogs with normal coronary arteries, Circ Res, 30, 67, 10.1161/01.RES.30.1.67 · DOI
  26. Sarnoff, 1958, Hemodynamic determinants of oxygen consumption of the heart with special reference to the tension-time index, Am J Physiol, 192, 148, 10.1152/ajplegacy.1957.192.1.148 · DOI
  27. Hoffman, 2014, The myocardial oxygen supply:demand index revisited, J Am Heart Assoc, 3, e000285, 10.1161/JAHA.113.000285 · DOI
  28. Nagueh, 2016, Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging, J Am Soc Echocardiogr, 29, 277, 10.1016/j.echo.2016.01.011 · DOI · Paper page
  29. Turer, 2011, Myocardial ischemia induced by rapid atrial pacing causes troponin T release detectable by a highly sensitive assay: insights from a coronary sinus sampling study, J Am Coll Cardiol, 57, 2398, 10.1016/j.jacc.2010.11.066 · DOI
  30. Cheng, 2013, Biomarkers of heart failure with normal ejection fraction: a systematic review, Eur J Heart Fail, 15, 1350, 10.1093/eurjhf/hft106 · DOI
  31. Saiki, 2017, Experimental cardiac radiation exposure induces ventricular diastolic dysfunction with preserved ejection fraction, Am J Physiol Heart Circ Physiol, 313, H392, 10.1152/ajpheart.00124.2017 · DOI
  32. Hwang, 2014, Implications of coronary artery disease in heart failure with preserved ejection fraction, J Am Coll Cardiol, 63, 2817, 10.1016/j.jacc.2014.03.034 · DOI
  33. Konerman, 2018, Reduced myocardial flow reserve is associated with diastolic dysfunction and decreased left atrial strain in patients with normal ejection fraction and epicardial perfusion, J Card Fail, 24, 90, 10.1016/j.cardfail.2017.10.010 · DOI
  34. Shah, 2018, Troponin in heart failure, Heart Fail Clin, 14, 57, 10.1016/j.hfc.2017.08.007 · DOI
  35. Pandey, 2017, Factors associated with and prognostic implications of cardiac troponin elevation in decompensated heart failure with preserved ejection fraction: findings from the American Heart Association Get With The Guidelines-Heart Failure Program, JAMA Cardiol, 2, 136, 10.1001/jamacardio.2016.4726 · DOI
  36. Felker, 2015, Serial high sensitivity cardiac troponin T measurement in acute heart failure: insights from the RELAX-AHF study, Eur J Heart Fail, 17, 1262, 10.1002/ejhf.341 · DOI

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Metadata

Authors
Obokata, M., Reddy, Y. N. V., Melenovsky, V., Kane, G. C., Olson, T. P., Jarolim, P., & Borlaug, B. A.
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2018-07
Volume
72
Issue
1
Pages
29-40
ISSN
0735-1097
DOI
10.1016/j.jacc.2018.04.039
PMC
PMC6034112
Cited by
151
References
5
Language
en
Licence

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