Cited by 656Cardiovascular Function and Risk FactorsCardiac Imaging and DiagnosticsCardiovascular Health and Disease Prevention

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Prevalence and correlates of coronary microvascular dysfunction in heart failure with preserved ejection fraction: PROMIS-HFpEF

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Shah, Sanjiv J, Lam, Carolyn S P, Svedlund, Sara, Saraste, Antti, Hage, Camilla, Tan, Ru-San, Beussink-Nelson, Lauren, Ljung Faxén, Ulrika, Fermer, Maria Lagerström, Broberg, Malin A, Gan, Li-Ming, Lund, Lars H·2018·European Heart Journal

DOI 10.1093/eurheartj/ehy531PMC PMC6927847

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Abstract

Aims: To date, clinical evidence of microvascular dysfunction in patients with heart failure (HF) with preserved ejection fraction (HFpEF) has been limited. We aimed to investigate the prevalence of coronary microvascular dysfunction (CMD) and its association with systemic endothelial dysfunction, HF severity, and myocardial dysfunction in a well defined, multi-centre HFpEF population. Methods and results: This prospective multinational multi-centre observational study enrolled patients fulfilling strict criteria for HFpEF according to current guidelines. Those with known unrevascularized macrovascular coronary artery disease (CAD) were excluded. Coronary flow reserve (CFR) was measured with adenosine stress transthoracic Doppler echocardiography. Systemic endothelial function [reactive hyperaemia index (RHI)] was measured by peripheral arterial tonometry. Among 202 patients with HFpEF, 151 [75% (95% confidence interval 69-81%)] had CMD (defined as CFR <2.5). Patients with CMD had a higher prevalence of current or prior smoking (70% vs. 43%; P = 0.0006) and atrial fibrillation (58% vs. 25%; P = 0.004) compared with those without CMD. Worse CFR was associated with higher urinary albumin-to-creatinine ratio (UACR) and NTproBNP, and lower RHI, tricuspid annular plane systolic excursion, and right ventricular (RV) free wall strain after adjustment for age, sex, body mass index, atrial fibrillation, diabetes, revascularized CAD, smoking, left ventricular mass, and study site (P < 0.05 for all associations). Conclusions: PROMIS-HFpEF is the first prospective multi-centre, multinational study to demonstrate a high prevalence of CMD in HFpEF in the absence of unrevascularized macrovascular CAD, and to show its association with systemic endothelial dysfunction (RHI, UACR) as well as markers of HF severity (NTproBNP and RV dysfunction). Microvascular dysfunction may be a promising therapeutic target in HFpEF.

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Corrigendum to: 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC.
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Authors: Shah, S. J., Lam, C. S. P., Svedlund, S., Saraste, A., Hage, C., Tan, R.-S., Beussink-Nelson, L., Ljung Faxén, U., Fermer, M. L., Broberg, M. A., Gan, L.-M., & Lund, L. H.
Affiliations: Northwestern University (US)
University Medical Center Groningen (NL)
Sahlgrenska University Hospital (SE)
University of Turku (FI)
Karolinska Institutet (SE)
National University of Singapore (SG)
Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Department of Medicine, Cardiology Unit and Heart and Vascular Theme, Karolinska Institutet, Stockholm, Sweden
Early Clinical Development, IMED Biotech Unit, AstraZeneca Gothenburg, Sweden
AstraZeneca (Sweden) (SE)
Corresponding author: Gan, Li-Ming
Lund, Lars H
ORCID: Shah, Sanjiv J
Lam, Carolyn S P
Svedlund, Sara
Saraste, Antti
Hage, Camilla
Tan, Ru-San
Gan, Li-Ming
Lund, Lars H
Venue: European Heart Journal
Publisher: Oxford University Press (OUP)
Published: 2018-08-27
Volume: 39
Issue: 37
Pages: 3439-3450
ISSN: 0195-668X (ISSN-L)
1522-9645
DOI: 10.1093/eurheartj/ehy531
PMC: PMC6927847
OpenAlex: W2889002990
Cited by: 656
References: 45
Citations by year: 2026: 79 · 2025: 91 · 2024: 100 · 2023: 98 · 2022: 93 · 2021: 73 · 2020: 67 · 2019: 48 · 2018: 5
FWCI: 36.35
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
Locations: European Heart Journal (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Funders: NIH
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
Keywords: heart failure with preserved ejection fraction, coronary microvascular dysfunction, coronary flow reserve, endothelial dysfunction, reactive hyperaemia index, albumin-creatinine ratio, NT-proBNP, right ventricular dysfunction, atrial fibrillation, smoking, prevalence
MeSH terms: Aged, Aged, 80 and over, Coronary Vessels, Female, Humans, Male, Middle Aged, Prospective Studies, Echocardiography, Doppler, Heart Failure, Diastolic, Microvessels

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Prevalence and correlates of coronary microvascular dysfunction in heart failure with preserved ejection fraction: PROMIS-HFpEF

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