PROMIS-HFpEF: Microvascular Dysfunction Prevalent in HFpEF

Coronary microvascular dysfunction (CMD) was prevalent in patients with heart failure with preserved ejection fraction (HFpEF), according to a new analysis.  

The authors, who presented the results at the 2018 European Society of Cardiology Congress in Munich, enrolled 202 patients with guideline-based HFpEF (and excluded patients with unrevascularized coronary artery disease). They then measured coronary flow reserve (CFR) by adenosine stress testing by Doppler echo, looking specifically at systemic endothelial function evaluated via peripheral arterial tonometry (using a reactive hyperaemia index [RHI]).  

Hotline paper from #ESCcongress – Prevalence and correlates of coronary microvascular dysfunction in heart failure with preserved ejection fraction #HFpEF : PROMIS-HFpEF https://t.co/BORYf3Ofdp@escardio #ESCCoT #freeaccess pic.twitter.com/HE2moUozNN

— European Society of Cardiology Journals (@ESC_Journals) August 29, 2018

According to the results, 151 patients with HFpEF had CMD. patients with CMD had higher prevalence of AFib (P=0.004) and current or prior smoking  (P=0.0006) than patients without CMD. Worsened CFR was linked with a number of problems, including higher urinary albumin-to-creatinine ratio and NTproBNP, lower RHI, tricuspid annular plane systolic excursion, and right ventricular free wall strain after adjusting for age, sex, body mass index, AFib, diabetes, revascularized CAD, smoking, left ventricular mass, and study site (P < 0.05 for all associations)

“PROMIS-HFpEF is the first prospective multicenter, 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),” the study researchers wrote. “Microvascular dysfunction may be a promising therapeutic target in HFpEF.” 

Great to see #IMED collaboration presented as late-breaking science at #ESC showing potential diagnostic approach for a difficult-to-diagnose heart disease https://t.co/HGlPmZnIXc

— Prof Sir Mene Pangalos FRS (@MenePangalos) August 28, 2018

Important article confirming earlier smaller trials (Drier et al @ajpheartcirc 2018) in large prospective setting. Free full text at @ESC_Journals https://t.co/3IOcpPmttr

— Andreas Gevaert (@AndreasGevaert) August 27, 2018

Coronary microvascular dysfunction may be a promising therapeutic target in HFpEF. See our paper in #EurHeartJ @ESC_Journals (https://t.co/kBtPu2glco) published simultaneously today with late-breaker presentation at #ESC2018 by @lamcardio. @NMCardiology @NorthwesternMed

— Sanjiv J. Shah, MD (@HFpEF) August 27, 2018

Among patients with HFpEF, without unrevascularized macrovascular CAD, 3 in 4 had coronary artery microvascular dysfunction which was associated with elevated subclinical markers of disease severity @ESC_Journals @HFpEF #ESCCongress https://t.co/FztVp7NKBQ

— Pradeep Natarajan (@pnatarajanmd) August 27, 2018

2/3 #ESCcongress #heartfailure wrapup @escardio

3. PROMIS-HFpEF: Coronary microvascular dysfunction prevalent, new target in #HFpEF https://t.co/MLxpYKezY3 @ESC_Journals

4. https://t.co/Ag2nZ7vTQ5: Medical therapy is the way to go in 2ry mitral regurg https://t.co/b4b0f09vTh

— Andreas Gevaert (@AndreasGevaert) August 29, 2018

Source: European Heart Journal