Evaluation Of Coronary Microcirculation Function In Patients With Heart Failure With Preserved Ejection Fraction

Part ?.Evaluation of coronary microcirculation function in heart failure with preserved ejection fraction patientsObjective To study the coronary microvascular function in patients with heart failure with preserved ejection fraction(HFp EF)using invasive pressure–temperature sensor guidewire.Methods This was a prospective study performed from July 2015 to December 2017.Patients complaining exertional dyspnea and with positive stress test were enrolled.All patients underwent echocardiography and cardiac catheterization examinations.Comparing clinical features and the values obtained in the examinations and were allocated into control group and HFp EF group according to left ventricle end diastolic pressure(LVEDP)16mm Hg,hypertensives with myocardial hypertrophy and health subjects as control groups,multivariate regression analysis was developed to analyze predictors of left ventricle end diastolic pressure(LVEDP).Results 92 subjects met with HFp EF diagnosis criteria,and control groups as 54 patients were in hypertensive group,and 17 patients in health control group.Patients in HFp EF group were more likely to be older,female,and had the most comorbidities,as diabetes mellitus,atrial fibrillation,chronic kidney dysfunction(CKD).The highest LVEDP with the most serious syndrome(NYHA ???)was in HFp EF.The index of microcirculatory resistance(IMR)significantly increased in HFp EF patients comparing to hpertensive patients and the health controls.CFR in HFp EF and hyertensive group was similarly reduced.In regression analysis,IMR was significantly linear correlation with LVEDP,and was the only independent predictors of LVEDP.Conclusions Increased IMR and reduced CFR was characters of microvascular dysfunction in HFp EF.IMR was independently positive linear correlated with LVEDP.Microvascular rarefaction might be a subsequent pathology progress in the development of HFp EF.Part ?.Analysis of coronary microcirculation function in older patients with heart failure with preserved ejection fractionObjective To explore the impaction of aging on coronary microcirculation function in patients with heart failure with preserved ejection fraction(HFp EF)by exploring the features of coronary microcirculation of older patients with heart failure with preserved ejection fraction.Methods 92 Patients with HFp EF in study part I were divided into 2 groups according to age 65,52 patients ? 65 years old in older group and 40 patients <65 years old in adult group.Comparing clinical features,such as gender,age,laboratory data,medications,echocardiographic and coronary physiologic parameters,and left ventricular end-diastolic pressure(LVEDP)to analyze the factors related to the index of microcirculatory resistance(IMR).Results Averaged age in older HFp EF group was near 74 years old,69% of patients were female,and 83% of older HFp EF patients comorbided with diabetes mellitus(DM),42% with chronic kidney dysfunction(CKD),and 60% with atrial fibrillation(AF),62% with NYHA ???.Averaged body mass index(BMI)in older group was lower than adult subjects,while the level of albumin to creatinine ratio(ACR)and brain natriuretic peptide(BNP)in older group was higher than adult group.Comorbidities of hypertension,hyperlipemia,chronic obstructive pulmonary disease(COPD)were not significantly different between groups,so were medications.Parameters obtained in echocardiography,left ventricular(LV)end diastolic volume index(EDVI),end diastolic volume index(ESVI)and ejection fraction(EF),heart rate(HR)had no difference between groups,averaged LV mass index in adults group was higher,but left atrial diameter(LAD),e',and E/e' in older group were higher.Coronary physiologic parameters basic mean transit time(Tmn)and hyperemic Tmn,IMR,and left ventricular end-diastolic pressure was significantly higher than the adult group,and fractional flow reserve(FFR),coronary flow reverse(CFR),coronary distal pressure(Pd)was no difference between groups.LVEDP,ACR,AF,DM,HFp EF were correlated with increased IMR,age and LVEDP were good predictors of increased IMR in multiple linear regression analysis.Inclusion Increased IMR and decreased CFR were the features of coronary microcirculatory in older patients with HFp EF,age and LVEDP were correlated to and predictors to increased IMR.