Matthew C Konerman1, Joshua C Greenberg2, Theodore J Kolias3, James R Corbett3, Ravi V Shah4, Venkatesh L Murthy3, Scott L Hummel5. 1. Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan. Electronic address: mkonerma@med.umich.edu. 2. Henry Ford Hospital, Detroit, Michigan. 3. Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan. 4. Massachusetts General Hospital, Harvard University, Boston, Massachusetts. 5. Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan.
Abstract
INTRODUCTION: Coronary microvascular dysfunction (MVD) may contribute to the pathogenesis of heart failure with preserved ejection fraction (HFpEF). Using myocardial flow reserve (MFR) measured by positron emission tomography (PET) as an assessment of microvascular function, we hypothesized that abnormal MFR is associated with LV diastolic dysfunction (DD) and reduced LV and LA strain in patients with risk factors for HFpEF and normal epicardial perfusion on cardiac PET. METHODS AND RESULTS: Retrospective study of patients without heart failure who underwent cardiac rubidium-82 PET and echocardiography. Global MFR was calculated as the ratio of global stress to rest myocardial blood flow. Echocardiographic measures of diastolic function were recorded. Global longitudinal LA and LV strain were measured with a 2-dimensional speckle-tracking technique. Relationships among MFR and echocardiographic measures were assessed with linear regression, analysis of variance, and test for trend. Seventy-three patients (age 64 ± 11 years, 52% male) were identified with no epicardial perfusion defect on cardiac PET and an ejection fraction ≥50%. Decreased MFR was associated with LV DD (P = .02) and increased E/e', an estimation of LV filling pressure (low E/e' [<8] vs. high E/e' [>15], P < .001). MFR was associated with LA strain independent of age, gender, and common comorbidities (adjusted β = 2.6% per unit MFR, P = 0.046); however, MFR was only marginally related to LV strain. CONCLUSIONS: In patients with risk factors for HFpEF, MVD assessed with MFR was associated with DD, increased estimated LV filling pressure, and abnormal LA strain.
INTRODUCTION:Coronary microvascular dysfunction (MVD) may contribute to the pathogenesis of heart failure with preserved ejection fraction (HFpEF). Using myocardial flow reserve (MFR) measured by positron emission tomography (PET) as an assessment of microvascular function, we hypothesized that abnormal MFR is associated with LV diastolic dysfunction (DD) and reduced LV and LA strain in patients with risk factors for HFpEF and normal epicardial perfusion on cardiac PET. METHODS AND RESULTS: Retrospective study of patients without heart failure who underwent cardiac rubidium-82 PET and echocardiography. Global MFR was calculated as the ratio of global stress to rest myocardial blood flow. Echocardiographic measures of diastolic function were recorded. Global longitudinal LA and LV strain were measured with a 2-dimensional speckle-tracking technique. Relationships among MFR and echocardiographic measures were assessed with linear regression, analysis of variance, and test for trend. Seventy-three patients (age 64 ± 11 years, 52% male) were identified with no epicardial perfusion defect on cardiac PET and an ejection fraction ≥50%. Decreased MFR was associated with LV DD (P = .02) and increased E/e', an estimation of LV filling pressure (low E/e' [<8] vs. high E/e' [>15], P < .001). MFR was associated with LA strain independent of age, gender, and common comorbidities (adjusted β = 2.6% per unit MFR, P = 0.046); however, MFR was only marginally related to LV strain. CONCLUSIONS: In patients with risk factors for HFpEF, MVD assessed with MFR was associated with DD, increased estimated LV filling pressure, and abnormal LA strain.
Authors: Manuel D Cerqueira; Neil J Weissman; Vasken Dilsizian; Alice K Jacobs; Sanjiv Kaul; Warren K Laskey; Dudley J Pennell; John A Rumberger; Thomas Ryan; Mario S Verani Journal: Circulation Date: 2002-01-29 Impact factor: 29.690
Authors: Christian Bruch; Matthias Grude; Joachim Müller; Günter Breithardt; Thomas Wichter Journal: Am J Cardiol Date: 2005-04-01 Impact factor: 2.778
Authors: Kajenny Srivaratharajah; Thais Coutinho; Robert deKemp; Peter Liu; Haissam Haddad; Ellamae Stadnick; Ross A Davies; Sharon Chih; Girish Dwivedi; Ann Guo; George A Wells; Jordan Bernick; Robert Beanlands; Lisa M Mielniczuk Journal: Circ Heart Fail Date: 2016-07 Impact factor: 8.790
Authors: Barry A Borlaug; Thomas P Olson; Carolyn S P Lam; Kelly S Flood; Amir Lerman; Bruce D Johnson; Margaret M Redfield Journal: J Am Coll Cardiol Date: 2010-09-07 Impact factor: 24.094
Authors: Wojciech Kosmala; Aleksandra Rojek; Monika Przewlocka-Kosmala; Andrzej Mysiak; Bozena Karolko; Thomas H Marwick Journal: J Am Coll Cardiol Date: 2016-02-16 Impact factor: 24.094
Authors: Bernhard A Herzog; Lars Husmann; Ines Valenta; Oliver Gaemperli; Patrick T Siegrist; Fabian M Tay; Nina Burkhard; Christophe A Wyss; Philipp A Kaufmann Journal: J Am Coll Cardiol Date: 2009-07-07 Impact factor: 24.094
Authors: Masaru Obokata; Yogesh N V Reddy; Vojtech Melenovsky; Garvan C Kane; Thomas P Olson; Petr Jarolim; Barry A Borlaug Journal: J Am Coll Cardiol Date: 2018-07-03 Impact factor: 24.094
Authors: Johnathan D Tune; Adam G Goodwill; Hana E Baker; Gregory M Dick; Cooper M Warne; Selina M Tucker; Salman I Essajee; Chastidy A Bailey; Jessica A Klasing; Jacob J Russell; Patricia E McCallinhart; Aaron J Trask; Shawn B Bender Journal: Basic Res Cardiol Date: 2022-10-12 Impact factor: 12.416
Authors: Marat Fudim; Andrew P Ambrosy; Jie-Lena Sun; Kevin J Anstrom; Bradley A Bart; Javed Butler; Omar AbouEzzeddine; Stephen J Greene; Robert J Mentz; Margaret M Redfield; Yogesh N V Reddy; Muthiah Vaduganathan; Eugene Braunwald; Adrian F Hernandez; Barry A Borlaug; G Michael Felker Journal: J Am Heart Assoc Date: 2018-12-18 Impact factor: 5.501