Lory Trevisan1, Jennifer Cautela1, Noemie Resseguier2, Marc Laine1, Stephane Arques3, Johan Pinto1, Morgane Orabona1, Jeremie Barraud1, Michael Peyrol1, Franck Paganelli4, Laurent Bonello4, Franck Thuny5. 1. Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, hôpital Nord, Aix-Marseille University, AP-HM, chemin des Bourrely, 13015 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France. 2. Department of Public Health, Research Unit EA 3279, Aix-Marseille University, 13005 Marseille, France. 3. Department of Cardiology, hôpital Aubagne, 13400 Aubagne, France. 4. Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, hôpital Nord, Aix-Marseille University, AP-HM, chemin des Bourrely, 13015 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France; Inserm, UMRS 1076, Aix-Marseille University, 13005 Marseille, France. 5. Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, hôpital Nord, Aix-Marseille University, AP-HM, chemin des Bourrely, 13015 Marseille, France; Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), 13015 Marseille, France. Electronic address: franck.thuny@gmail.com.
Abstract
BACKGROUND: Guidelines recommend careful screening and treatment of coronary artery disease (CAD) in heart failure with preserved or mid-range ejection fraction (HFpEF/HFmEF). AIM: We aimed to determine the prevalence and characteristics of CAD using a prospective systematic coronary angiography approach. METHODS: A systematic coronary angiography protocol was applied in consecutive patients admitted for HFpEF/HFmEF during a 6-month period in a single centre. History of CAD and results of angiography, including revascularization, were reported. RESULTS: Of the 164 patients with HFpEF/HFmEF who were included, an angiography assessment was applied in 108 (66%) (median age: 79 years [interquartile range: 70-85 years]; 54% were women). In our analysis, 64% (95% confidence interval [CI] 55-73%) of patients had a significant coronary stenosis corresponding to a global CAD prevalence of 80% (95% CI 73-88%). The prevalence of CAD was similar for HFpEF and HFmEF. The left main coronary artery presented a significant stenosis in 6.5% of cases and 39% of patients had a two- or three-vessel disease. The rate of significant coronary stenosis was non-significantly higher in patients with a history of CAD. Patients with HFpEF/HFmEF with and without CAD did not differ in clinically meaningful ways, in terms of symptoms or laboratory and echocardiography results. This strategy led to complete revascularization in 36% of patients with significant stenosis and in 23% of all patients with HFpEF/HFmEF. CONCLUSIONS: Our study differs from others in that we used a systematic angiography approach. The results suggest a much higher prevalence of CAD in HFpEF/HFmEF than previously reported and should encourage clinicians to aggressively identify this co-morbidity.
BACKGROUND: Guidelines recommend careful screening and treatment of coronary artery disease (CAD) in heart failure with preserved or mid-range ejection fraction (HFpEF/HFmEF). AIM: We aimed to determine the prevalence and characteristics of CAD using a prospective systematic coronary angiography approach. METHODS: A systematic coronary angiography protocol was applied in consecutive patients admitted for HFpEF/HFmEF during a 6-month period in a single centre. History of CAD and results of angiography, including revascularization, were reported. RESULTS: Of the 164 patients with HFpEF/HFmEF who were included, an angiography assessment was applied in 108 (66%) (median age: 79 years [interquartile range: 70-85 years]; 54% were women). In our analysis, 64% (95% confidence interval [CI] 55-73%) of patients had a significant coronary stenosis corresponding to a global CAD prevalence of 80% (95% CI 73-88%). The prevalence of CAD was similar for HFpEF and HFmEF. The left main coronary artery presented a significant stenosis in 6.5% of cases and 39% of patients had a two- or three-vessel disease. The rate of significant coronary stenosis was non-significantly higher in patients with a history of CAD. Patients with HFpEF/HFmEF with and without CAD did not differ in clinically meaningful ways, in terms of symptoms or laboratory and echocardiography results. This strategy led to complete revascularization in 36% of patients with significant stenosis and in 23% of all patients with HFpEF/HFmEF. CONCLUSIONS: Our study differs from others in that we used a systematic angiography approach. The results suggest a much higher prevalence of CAD in HFpEF/HFmEF than previously reported and should encourage clinicians to aggressively identify this co-morbidity.
Authors: Renato D Lopes; Karen P Alexander; Susanna R Stevens; Harmony R Reynolds; Gregg W Stone; Ileana L Piña; Frank W Rockhold; Ahmed Elghamaz; Jose Luis Lopez-Sendon; Pedro S Farsky; Alexander M Chernyavskiy; Ariel Diaz; Denis Phaneuf; Mark A De Belder; Yi-Tong Ma; Luis A Guzman; Michel Khouri; Alessandro Sionis; Derek J Hausenloy; Rolf Doerr; Joseph B Selvanayagam; Aldo Pietro Maggioni; Judith S Hochman; David J Maron Journal: Circulation Date: 2020-08-29 Impact factor: 29.690
Authors: Jenine E John; Brian Claggett; Hicham Skali; Scott D Solomon; Jonathan W Cunningham; Kunihiro Matsushita; Suma H Konety; Dalane W Kitzman; Thomas H Mosley; Donald Clark; Patricia P Chang; Amil M Shah Journal: J Am Heart Assoc Date: 2022-08-24 Impact factor: 6.106