Abnormal Left Ventricular Subendocardial Perfusion and Diastolic Function in Women with Obesity and Heart Failure and Preserved Ejection Fraction

Overview

Journal Int J Cardiovasc Imaging

Publisher Springer

Specialty Radiology

Date 2023 Jan 6

PMID 36607469

Authors

Roshanak Markley

Marco Giuseppe Del Buono

Virginia Mihalick

Alexander Pandelidis

Cory Trankle

Jennifer H Jordan

Kevin DeCamp

Chris Winston

Salvatore Carbone

Hayley Billingsley

Andrew Barron

Georgia Thomas

Benjamin Van Tassell

W Gregory Hundley

Peter Kellman

Antonio Abbate

Affiliations

Soon will be listed here.

Abstract

Purpose: - Coronary microvascular dysfunction (CMD) is common in patients with heart failure with preserved ejection fraction (HFpEF) and obesity. Stress cardiovascular magnetic resonance (CMR) has been proposed as a non-invasive tool for detection of CMD. The aim of this study was to determine relationship between CMD and diastolic function in patients with HFpEF using a novel CMR technique.

Methods: - Patients with obesity and HFpEF without epicardial coronary artery disease (CAD) underwent Doppler echocardiography to measure diastolic function, followed by vasodilator stress CMR, using a single bolus, dual sequence, quantitative myocardial perfusion mapping to measure myocardial blood flow (MBF) at rest and at peak hyperemia. With this, myocardial perfusion reserve (MPR), global stress endocardial-to-epicardial (endo:epi) perfusion ratio, and total ischemic burden (IB, defined as myocardial segments with MBF < 1.94 mL/min/g) were calculated. Results are reported as median and interquartile range.

Results: - Nineteen subjects were enrolled (100% female, 42% Black). Median age was 64 [56-72] years. Global stress MBF was 2.43 ml/min/g [2.16-2.78] and global myocardial perfusion reserve (MPR) was 2.34 [2.07-2.88]. All had an abnormal subendocardial perfusion with an endo:epi of less than 1 (0.87 [0.81-0.90]). Regional myocardial hypoperfusion was detected in 14 (74%) patients with an IB of 6% [0-34.4]. Endo:epi ratio significantly correlated with IB (R=-0.510, p = 0.026) and measures of diastolic function (R = 0.531, p = 0.019 and R=-0.544, p = 0.014 for e' and E/e' respectively).

Conclusion: - Using a novel quantitative stress CMR myocardial perfusion mapping technique, women with obesity and HFpEF were found to have patterns of abnormal subendocardial perfusion which significantly correlated with measures of diastolic dysfunction.

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