Aims Coronary microvascular ischaemia, cardiomyocyte injury and stiffness may play an important role in the pathophysiology of heart failure with preserved ejection fraction (HFpEF). To date, the relationship between coronary flow reserve (CFR), myocardial injury, diastolic dysfunction, and future HFpEF risk is unknown. Methods and results Consecutive patients (n = 201) undergoing evaluation for suspected coronary artery disease (CAD) with stress myocardial perfusion positron emission tomography, serum troponin, and transthoracic echocardiography who did not have flow-limiting CAD or reduced left ventricular ejection fraction were identified. Patients were followed up (median 4.1 years) for cardiovascular death and hospitalization for non-fatal myocardial infarction or heart failure. Coronary flow reserve was quantified as stress/rest myocardial blood flow. Early diastolic flow (E) and relaxation (e') velocities were obtained via transmitral and tissue Doppler, respectively. Patients with impaired CFR (<2, n = 108) demonstrated linearly decreasing e' and increasing E/e' consistent with worsening diastolic function (P for trend <0.0001). A detectable troponin was associated with diastolic dysfunction only in the presence of impaired CFR (interaction P = 0.002). In adjusted analyses, impaired CFR was independently associated with diastolic dysfunction (E/e'septal > 15, adjusted OR 2.58, 95%CI 1.22-5.48) and composite cardiovascular outcomes or HFpEF hospitalization alone (adjusted HR 2.47, 95%CI 1.09-5.62). Patients with both impaired CFR and diastolic dysfunction demonstrated >five-fold increased risk of HFpEF hospitalization (P < 0.001). Conclusion In symptomatic patients without overt CAD, impaired CFR was independently associated with diastolic dysfunction and adverse events, especially HFpEF hospitalization. The presence of both coronary microvascular and diastolic dysfunctions was associated with a markedly increased risk of HFpEF events.

中文翻译：

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冠状动脉微血管功能障碍和射血分数保留的心力衰竭的未来风险

目的 冠状动脉微血管缺血、心肌细胞损伤和僵硬可能在射血分数保留的心力衰竭 (HFpEF) 的病理生理学中起重要作用。迄今为止，冠状动脉血流储备 (CFR)、心肌损伤、舒张功能障碍和未来 HFpEF 风险之间的关系尚不清楚。方法和结果 通过负荷心肌灌注正电子发射断层扫描、血清肌钙蛋白和经胸超声心动图评估疑似冠状动脉疾病 (CAD) 的连续患者 (n = 201) 被确定为没有血流限制性 CAD 或左心室射血分数降低. 对患者的心血管死亡和非致命性心肌梗塞或心力衰竭住院进行了随访（中位时间为 4.1 年）。冠状动脉血流储备被量化为应激/静息心肌血流量。早期舒张血流 (E) 和舒张 (e') 速度分别通过二尖瓣和组织多普勒获得。CFR 受损 (<2, n = 108) 的患者表现出线性下降的 e' 和增加的 E/e' 与恶化的舒张功能一致（趋势 P <0.0001）。仅在 CFR 受损的情况下，可检测到的肌钙蛋白与舒张功能障碍相关（相互作用 P = 0.002）。在调整后的分析中，受损的 CFR 与舒张功能障碍（E/e'septal > 15，调整后的 OR 2.58，95%CI 1.22-5.48）和复合心血管结局或单独的 HFpEF 住院（调整后的 HR 2.47，95%CI 1.09- 5.62）。CFR 受损和舒张功能障碍的患者均表现出 > HFpEF 住院风险增加五倍（P < 0.001）。结论 在没有明显 CAD 的有症状患者中，CFR 受损与舒张功能障碍和不良事件，尤其是 HFpEF 住院独立相关。冠状动脉微血管和舒张功能障碍的存在与 HFpEF 事件的风险显着增加有关。