Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Feb 2016)

Impairment of Coronary Flow Reserve Evaluated by Phase Contrast Cine‐Magnetic Resonance Imaging in Patients With Heart Failure With Preserved Ejection Fraction

  • Shingo Kato,
  • Naka Saito,
  • Hidekuni Kirigaya,
  • Daiki Gyotoku,
  • Naoki Iinuma,
  • Yuka Kusakawa,
  • Kohei Iguchi,
  • Tatsuya Nakachi,
  • Kazuki Fukui,
  • Masaaki Futaki,
  • Tae Iwasawa,
  • Kazuo Kimura,
  • Satoshi Umemura

DOI
https://doi.org/10.1161/JAHA.115.002649
Journal volume & issue
Vol. 5, no. 2

Abstract

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BackgroundPhase contrast (PC) cine‐magnetic resonance imaging (MRI) of the coronary sinus allows for noninvasive evaluation of coronary flow reserve (CFR), which is an index of left ventricular microvascular function. The objective of this study was to investigate coronary flow reserve in patients with heart failure with preserved ejection fraction (HFpEF). Methods and ResultsWe studied 25 patients with HFpEF (mean and SD of age: 73±7 years), 13 with hypertensive left ventricular hypertrophy (LVH) (67±10 years), and 18 controls (65±15 years). Breath‐hold PC cine‐MRI images of the coronary sinus were obtained to assess blood flow at rest and during ATP infusion. CFR was calculated as coronary sinus blood flow during ATP infusion divided by coronary sinus blood flow at rest. Impairment of CFR was defined as CFR <2.5 according to a previous study. The majority (76%) of HFpEF patients had decreased CFR. CFR was significantly decreased in HFpEF patients in comparison to hypertensive LVH patients and control subjects (CFR: 2.21±0.55 in HFpEF vs 3.05±0.74 in hypertensive LVH, 3.83±0.73 in controls; P<0.001 by 1‐way ANOVA). According to multivariable linear regression analysis, CFR independently and significantly correlated with serum brain natriuretic peptide level (β=−68.0; 95% CI, −116.2 to −19.7; P=0.007). ConclusionsCFR was significantly lower in patients with HFpEF than in hypertensive LVH patients and controls. These results indicated that impairment of CFR might be a pathophysiological factor for HFpEF and might be related to HFpEF disease severity.

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