The Pathophysiology of Heart Failure With Normal Ejection Fraction

Tan, Yu Ting; Wenzelburger, Frauke; Lee, Eveline; Heatlie, Grant; Leyva, Francisco; Patel, Kiran; Frenneaux, Michael; Sanderson, John E.

doi:10.1016/j.jacc.2009.03.037

Cited by 436 publications

(102 citation statements)

References 52 publications

(58 reference statements)

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“…Previous studies showed that CFR is impaired in hypertrophic cardiomyopathy,12 HF,18 and dilated cardiomyopathy 16. In HFpEF patients, a subtle abnormality of resting myocardial function becomes apparent during the stress condition 19, 20, 21. Therefore, we hypothesized that CFR might be decreased in patients with HFpEF.…”

Section: Introductionmentioning

confidence: 94%

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

Kato

Saito

Kirigaya

et al. 2016

JAHA

108

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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).Conclusions CFR 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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Section: Introductionmentioning

confidence: 94%

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

Kato

Saito

Kirigaya

et al. 2016

JAHA

108

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show abstract

“…Tan, et al 170 combined traditional and newer echocardiographic parameters in their examination of patients at rest and during aerobic exercise. They proposed that in HFNEF, both systolic and diastolic abnormalities cause exercise limitation, particularly involving ventricular twist, delayed untwisting and deformation (strain).…”

Section: Diastolic Stress Testmentioning

confidence: 99%

Echocardiographic evaluation of diastolic heart failure

Thomas

2010

Australas J Ultrason Med

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“…17 Although both the subendocardial and the subepicardial longitudinal fibers contribute to longitudinal deformation, in the normal heart, they counterbalance each other's ability to produce circumferential deformation. The subendocardial fibers seem more susceptible to dysfunction 10,18 than the mid and epicardial fibers. This impairment of the subendocardial longitudinal fibers also leads to attenuated subendocardial right-handed helix fiber shortening during systole, potentially resulting in a failure to fully counterbalance the subepicardial left-handed helix fiber shortening and resulting in increased circumferential deformation.…”

mentioning

confidence: 94%