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Abstract
Aims
Several mechanisms have been identified in the aetiopathogenesis of heart failure with preserved ejection fraction (HFpEF). Among these, coronary microvascular dysfunction (CMD) may play a key pathophysiological role. We performed a systematic review and meta‐analysis to investigate the prevalence, echocardiographic correlates, and prognostic implications of CMD in patients with HFpEF.
Methods and results
A systematic search for articles up to 1 May 2023 was performed. The primary aim was to assess the prevalence of CMD. Secondary aims were to compare key echocardiographic parameters (E/e′ ratio, left atrial volume index [LAVi], and left ventricular mass index [LVMi]), clinical outcomes [death and hospitalization for heart failure (HF)], and prevalence of atrial fibrillation (AF) between patients with and without CMD. Meta‐regressions according to baseline patient characteristics and study features were performed to explore potential heterogeneity sources. We identified 14 observational studies, enrolling 1138 patients with HFpEF. The overall prevalence of CMD was 58%. Compared with patients without CMD, patients with HFpEF and CMD had larger LAVi [mean difference (MD) 3.85 confidence interval (CI) 1.19–6.5, P < 0.01)], higher E/e′ ratio (MD 2.76 CI 1.54–3.97; P < 0.01), higher prevalence of AF (odds ratio 1.61 CI 1.04–2.48, P = 0.03) and higher risk of death or hospitalization for HF [hazard ratio 3.19, CI 1.04–9.57, P = 0.04].
Conclusions
CMD is present in little more than half of the patients with HFpEF and is associated with echocardiographic evidence of more severe diastolic dysfunction and a higher prevalence of AF, doubling the risk of death or HF hospitalization.
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Details
1 Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy, Division of Cardiology, AOU Maggiore della Carità, Novara, Italy
2 Catholic University of the Sacred Heart, Rome, Italy
3 Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
4 Department of Cardiothoracovascular, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy, Department of Medicine, Division of Cardiology, Karolinska Institutet, Stockholm, Sweden
5 Cardiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
6 Centre for Clinical & Basic Research, IRCCS San Raffaele Pisana, Rome, Italy, St George's Hospital Medical School, London, UK
7 National Heart Centre Singapore, Central Singapore, Singapore, Duke‐National University of Singapore Medical School, Central Singapore, Singapore
8 Department of Medicine, Division of Cardiology, Karolinska Institutet, Stockholm, Sweden, Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
9 Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy