Coronary Microvascular Dysfunction and Cardiovascular Risk in Obese Patients

Bajaj, Navkaranbir S.; Osborne, Michael T.; Gupta, Ankur; Tavakkoli, Ali; Bravo, Paco E.; Vita, Tomás; Bibbo, Courtney; Hainer, Jon; Dorbala, Sharmila; Blankstein, Ron; Bhatt, Deepak L.; Carli, Marcelo F. Di; Taqueti, Viviany R.

doi:10.1016/j.jacc.2018.05.049

Cited by 133 publications

(124 citation statements)

References 44 publications

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“…Recent studies, editorial commentaries and reviews have begun to embrace the potential importance of CMD in the pathophysiology of HFpEF . In an autopsy study, patients with HFpEF displayed a higher prevalence of microscopic hypertrophy, coronary microvascular rarefaction, and fibrosis than age‐matched controls .…”

Section: Discussionmentioning

confidence: 99%

“…This finding suggests that dedicated testing, using non‐invasive and invasive physiology methodologies, are needed to optimally evaluate coronary microvascular function in HFpEF patients. As new therapies are developed that target microvascular dysfunction, accurate identification of patients will be of even greater clinical importance …”

Section: Discussionmentioning

confidence: 99%

“…Recent studies, editorial commentaries and reviews have begun to embrace the potential importance of CMD in the pathophysiology Table 4 Cardiac structure, function, and intracoronary haemodynamics in heart failure with preserved ejection fraction patients with and without endothelium-independent coronary microvascular dysfunction 2.81, 95% CI 0.94-8.34, P=0. 3.56, 95% CI 1.14-11.12, P=0 of HFpEF. 1,2,[4][5][6][7][8][9]11,14,26 In an autopsy study, patients with HFpEF displayed a higher prevalence of microscopic hypertrophy, coronary microvascular rarefaction, and fibrosis than age-matched controls. 2 In patients with HFpEF but no significant epicardial coronary disease, plasma high-sensitivity troponins, markers of cardiac injury, were found to be more than twofold higher in subjects with HFpEF at rest, with even greater separation during exercise compared with control subjects.…”

Section: Coronary Microvascular Dysfunction and Hfpefmentioning

confidence: 99%

“…Patients with obesity in general display lower coronary microvascular density, 29 which when combined with alterations in vasomotor function related to adipose tissue-derived pro-inflammatory cytokines, are believed to contribute to CMD in obesity. 26,30,31 The consequent reductions in myocardial blood flow in obesity-related HFpEF from microvascular dysfunction, 32 in combination with greater cardiac metabolic demand due to increases in ventricular mass, volume expansion, higher filling pressures, and greater cardiac output may result in a 'perfect storm' for the occurrence of myocardial oxygen supply-demand mismatch. The combination of these factors may further predispose to development of ischaemia in the setting of CMD by increasing myocardial oxygen demand in obesity-related HFpEF.…”

Section: Microvascular Function and Left Ventricular Diastolic Relaxamentioning

confidence: 99%

“…As new therapies are developed that target microvascular dysfunction, accurate identification of patients will be of even greater clinical importance. [4][5][6]9,26…”

Section: Microvascular Function and Left Ventricular Diastolic Relaxamentioning

confidence: 99%

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Endothelium‐dependent and independent coronary microvascular dysfunction in patients with heart failure with preserved ejection fraction

Yang

Obokata

Reddy

et al. 2019

European J of Heart Fail

115

103

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Background Coronary microvascular inflammation is hypothesized to play a fundamental role in the pathophysiology of heart failure with preserved ejection fraction (HFpEF). No study has directly evaluated both endothelium‐dependent and independent coronary microvascular function in HFpEF. Methods and results Consecutive patients with HFpEF undergoing invasive coronary physiologic testing and echocardiography were examined. Endothelial function was quantified by the increase in coronary blood flow in response to intracoronary infusion of acetylcholine (10−6–10−4 mol/L) using a Doppler flow wire with quantitative angiography. Endothelium‐independent coronary microvascular function was assessed by the hyperaemic increase in coronary flow reserve in response to adenosine infusion. Among 162 HFpEF patients (67% women), coronary microvascular function was abnormal in 117 (72%). Isolated endothelium‐dependent microvascular dysfunction was present in 47 patients (29%), isolated endothelium‐independent microvascular dysfunction in 53 patients (33%), and combined microvascular dysfunction in 17 patients (10%). The presence of coronary microvascular dysfunction was not identifiable from medical co‐morbidities or other clinical characteristics. As compared to patients with normal endothelium‐independent function, HFpEF patients with endothelium‐independent coronary microvascular dysfunction displayed lower diastolic relaxation velocities (7.0 ± 1.8 vs. 8.4 ± 2.9 cm/s, P = 0.002) and higher estimated filling pressures (E/e' 13.1 ± 4.1 vs. 9.6 ± 3.4, P < 0.001). There were no relationships between left ventricular structure, function, or haemodynamics and endothelium‐dependent coronary vasodilatation. Endothelium‐independent microvascular dysfunction was associated with increased mortality. Conclusions Coronary microvascular dysfunction is common in patients with HFpEF and is caused equally by endothelium‐dependent and independent mechanisms, but the presence of microvascular dysfunction cannot be identified from clinical markers and co‐morbidities alone. Patients with HFpEF and endothelium‐independent microvascular dysfunction display worse diastolic dysfunction and outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Coronary Microvascular Dysfunction and Hfpefmentioning

confidence: 99%

Section: Microvascular Function and Left Ventricular Diastolic Relaxamentioning

confidence: 99%

“…As new therapies are developed that target microvascular dysfunction, accurate identification of patients will be of even greater clinical importance. [4][5][6]9,26…”

Section: Microvascular Function and Left Ventricular Diastolic Relaxamentioning

confidence: 99%

See 3 more Smart Citations

Endothelium‐dependent and independent coronary microvascular dysfunction in patients with heart failure with preserved ejection fraction

Yang

Obokata

Reddy

et al. 2019

European J of Heart Fail

115

103

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Obesity: the perfect storm for heart failure

Lembo,

Strisciuglio,

Fonderico

et al. 2024

ESC Heart Failure

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Obesity condition causes morphological and functional alterations involving the cardiovascular system. These can represent the substrates for different cardiovascular diseases, such as atrial fibrillation, coronary artery disease, sudden cardiac death, and heart failure (HF) with both preserved ejection fraction (EF) and reduced EF. Different pathogenetic mechanisms may help to explain the association between obesity and HF including left ventricular remodelling and epicardial fat accumulation, endothelial dysfunction, and coronary microvascular dysfunction. Multi‐imaging modalities are required for appropriate recognition of subclinical systolic dysfunction typically associated with obesity, with echocardiography being the most cost‐effective technique. Therapeutic approach in patients with obesity and HF is challenging, particularly regarding patients with preserved EF in which few strategies with high level of evidence are available. Weight loss is of extreme importance in patients with obesity and HF, being a primary therapeutic intervention. Sodium–glucose co‐transporter‐2 inhibitors have been recently introduced as a novel tool in the management of HF patients. The present review aims at analysing the most recent studies supporting pathogenesis, diagnosis, and management in patients with obesity and HF.

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Novel nuclear medical procedures in the detection of microvascular dysfunction

Milojevic

Kozarevic

Šobić-Šaranović

2022

J of Clinical Ultrasound

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Coronary microvascular dysfunction is present in two‐thirds of patients showing symptoms and signs of myocardial ischemia. Their microcirculation has abnormalities due to endothelial and smooth muscle cell dysfunction. Impairment of this mechanism causes a high risk of adverse cardiovascular event. Diagnosing coronary microvascular dysfunction is challenging. Guidelines recommend the use of nuclear medicine procedures in the above‐mentioned indications. Myocardial perfusion imaging with positron emission tomography is a novel procedure with high diagnostic accuracy and quality of images. It has short acquisition, low effective radiation dose and prognostic factors. There are still unknowns about this procedure and all its benefits.

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Coronary Microvascular Dysfunction and Cardiovascular Risk in Obese Patients

Abstract: In patients referred for testing, CMD was independently associated with elevated BMI and adverse outcomes, and was a better discriminator of risk than BMI and traditional risk factors. CFR may facilitate management of obese patients beyond currently used markers of risk.

Cited by 133 publications

References 44 publications

Endothelium‐dependent and independent coronary microvascular dysfunction in patients with heart failure with preserved ejection fraction

Endothelium‐dependent and independent coronary microvascular dysfunction in patients with heart failure with preserved ejection fraction

Obesity: the perfect storm for heart failure

Novel nuclear medical procedures in the detection of microvascular dysfunction

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