Quantitative perfusion CMR with adenosine for the assessment of coronary microvascular disease in heart failure with preserved ejection fraction patients
Ana Ezponda Casajus, Pamplona / Spain
Author Block: A. Ezponda Casajus1, C. Mbongo1, P. Kellman2, A. González Miqueo1, G. Bastarrika Alemañ1; 1Pamplona/ES, 2Bethseda, MD/USPurpose: Coronary microvascular disease (CMD) is a main mechanism in the development of diastolic dysfunction, a condition frequently observed in heart failure with preserved ejection fraction (HFpEF) patients. Quantitative stress perfusion cardiovascular magnetic resonance (CMR) is a useful non-invasive technique for the assessment of CMD. The aim of our study was to compare myocardial perfusion reserve (MPR) and myocardial blood flow (MBF) values by using an adenosine stress/rest quantitative perfusion CMR protocol in stage-B (asymptomatic with known risk factors and diastolic dysfunction) and stage-C (with signs and symptoms) HFpEF patients.Methods or Background: Between December 2021 and November 2022, 39 HFpEF patients (23 in stage-B and 16 in C) underwent quantitative CMR with adenosine for the assessment of CMD. None of the patients had a prior history of severe CAD. Global MBF during rest, stress and MPR indices were calculated using automated pixelwise quantitative myocardial perfusion mapping. Demographics and cardiovascular disorders and risk factors were recorded for the different groups of the HFpEF cohort.Results or Findings: Stage-B and stage-C patients do not present statistically significant differences in cardiovascular risk factors nor in prior medical history. Stage-C patients were significantly older than stage B patients (- 8n ±5.2 vs 67.1 ±8.4 years old, p <0.001). Stage-C HFpEF patients presented a significantly lower median of global MPR compared to stage B HFpEF patients (2.31, IQR 1.72-2.74 vs 3.20, IQR 2.80-3.55; p =0,004). Regarding stress perfusion values, global median endocardial BF was also significantly lower in patients at stage C (1.60, IQR 1.22-2.05 vs 2.23, IQR 1.66-2.55; p =0,044). There were no significant differences in rest MBF values between groups.
Conclusion: Stage-C HFpEF patients present significant lower values of non-invasive biomarkers of MCD evaluated with quantitative perfusion CMR, than asymptomatic HFpEF patients.Limitations: No limitations were identified.Funding for this study: CRUCIAL (H2020): this project has received funding from the SESAR Joint Undertaking under the European Union's Horizon 2020 research and innovation programme under grant agreement No Has your study been approved by an ethics committee? YesEthics committee - additional information: This study was approved by the ethics committee of the Clínica Universidad de Navarra.