Frequency of Coronary Microvascular Dysfunction and Diffuse Myocardial Fibrosis (Measured by Cardiovascular Magnetic Resonance) in Patients With Heart Failure and Preserved Left Ventricular Ejection Fraction
Heart failure with preserved ejection fraction (HFpEF) is frequently accompanied by co-morbidities and a systemic proinflammatory state, resulting in coronary microvascular dysfunction (CMD), as well as myocardial fibrosis. The purpose of this study is to examine the relation between myocardial perf...
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| Veröffentlicht in: | The American journal of cardiology 2019-11, Vol.124 (10), p.1584-1589 |
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| creator | Löffler, Adrián I. Pan, Jonathan A. Balfour, Pelbreton C. Shaw, Peter W. Yang, Yang Nasir, Moiz Auger, Daniel A. Epstein, Frederick H. Kramer, Christopher M. Gan, Li-Ming Salerno, Michael |
| description | Heart failure with preserved ejection fraction (HFpEF) is frequently accompanied by co-morbidities and a systemic proinflammatory state, resulting in coronary microvascular dysfunction (CMD), as well as myocardial fibrosis. The purpose of this study is to examine the relation between myocardial perfusion reserve (MPR) and diffuse myocardial fibrosis in patients with HFpEF using cardiovascular magnetic resonance. A single center study was performed in 19 patients with clinical HFpEF and 15 healthy control subjects who underwent quantitative first-pass perfusion imaging to calculate global MPR. T1 mapping was used to assess fibrosis and to calculate extracellular volume. Spiral cine displacement encoded stimulated echo was used to calculate myocardial strain. Comprehensive 2D echocardiograms with speckle tracking, cardiopulmonary exercise testing, and brain natriuretic peptide levels were also obtained. In patients with HFpEF, mean left ventricular EF was 61% ± 9% and left ventricular mass index 45 ± 12 g/m2. Compared with controls, HFpEF patients had reduced global MPR (2.29 ± 0.64 vs 3.38 ± 0.76, p = 0.002) and VO2 max (16.5 ± 6.8 vs 30.9 ± 7.7 ml/kg min, p |
| doi_str_mv | 10.1016/j.amjcard.2019.08.011 |
| format | Article |
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The purpose of this study is to examine the relation between myocardial perfusion reserve (MPR) and diffuse myocardial fibrosis in patients with HFpEF using cardiovascular magnetic resonance. A single center study was performed in 19 patients with clinical HFpEF and 15 healthy control subjects who underwent quantitative first-pass perfusion imaging to calculate global MPR. T1 mapping was used to assess fibrosis and to calculate extracellular volume. Spiral cine displacement encoded stimulated echo was used to calculate myocardial strain. Comprehensive 2D echocardiograms with speckle tracking, cardiopulmonary exercise testing, and brain natriuretic peptide levels were also obtained. In patients with HFpEF, mean left ventricular EF was 61% ± 9% and left ventricular mass index 45 ± 12 g/m2. Compared with controls, HFpEF patients had reduced global MPR (2.29 ± 0.64 vs 3.38 ± 0.76, p = 0.002) and VO2 max (16.5 ± 6.8 vs 30.9 ± 7.7 ml/kg min, p <0.001) whereas extracellular volume (0.29 ± 0.04 vs 0.25 ± 0.04, p = 0.02), pulmonary artery systolic pressure (35.4 ± 13.7 vs 22.3 ± 5.4 mm Hg, p = 0.004), and average E/e’ (15.0 ± 7.6 vs 8.6 ± 2.0, p = 0.005) were increased. Displacement encoded stimulated echo peak systolic circumferential strain (p = 0.60) as well as echocardiographic derived global longitudinal strain (p = 0.07) were similar between both groups. The prevalence of CMD, defined as global MPR <2.5, in the HFpEF group was 69%. In conclusion, HFpEF patients have a high prevalence of CMD and diffuse fibrosis. These parameters may be useful clinical end points for future therapeutic trials.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2019.08.011</identifier><identifier>PMID: 31575425</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adenosine ; Age ; Aged ; Blood pressure ; Brain natriuretic peptide ; Cardiomyopathies - diagnosis ; Cardiomyopathies - epidemiology ; Cardiomyopathies - physiopathology ; Cardiovascular disease ; Clinical trials ; Comorbidity ; Congestive heart failure ; Coronary Artery Disease - diagnosis ; Coronary Artery Disease - epidemiology ; Coronary Artery Disease - physiopathology ; Coronary Circulation - physiology ; Echocardiography ; Ejection fraction ; Female ; Fibrosis ; Fibrosis - diagnosis ; Fibrosis - epidemiology ; Fibrosis - physiopathology ; Heart ; Heart failure ; Heart Failure - diagnosis ; Heart Failure - epidemiology ; Heart Failure - physiopathology ; Heart rate ; Heart Ventricles - diagnostic imaging ; Heart Ventricles - physiopathology ; Humans ; Hypertension ; Incidence ; Inflammation ; Magnetic resonance ; Magnetic Resonance Imaging, Cine - methods ; Male ; Mapping ; Mathematical analysis ; Mercury ; Metabolism ; Microcirculation - physiology ; Microvasculature ; Middle Aged ; Myocardium - pathology ; Neuroimaging ; Oxygen consumption ; Perfusion ; Prevalence ; Pulmonary arteries ; Pulmonary artery ; Resonance ; Stroke Volume - physiology ; Systolic pressure ; Ultrasonic imaging ; United States - epidemiology ; Ventricle ; Ventricular Function, Left</subject><ispartof>The American journal of cardiology, 2019-11, Vol.124 (10), p.1584-1589</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><rights>2019. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c440t-bcf6e75ebd99ecff46a337e953915fea16329738a15046b899edf5c34493f963</citedby><cites>FETCH-LOGICAL-c440t-bcf6e75ebd99ecff46a337e953915fea16329738a15046b899edf5c34493f963</cites><orcidid>0000-0002-2841-4243</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914919309506$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31575425$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Löffler, Adrián I.</creatorcontrib><creatorcontrib>Pan, Jonathan A.</creatorcontrib><creatorcontrib>Balfour, Pelbreton C.</creatorcontrib><creatorcontrib>Shaw, Peter W.</creatorcontrib><creatorcontrib>Yang, Yang</creatorcontrib><creatorcontrib>Nasir, Moiz</creatorcontrib><creatorcontrib>Auger, Daniel A.</creatorcontrib><creatorcontrib>Epstein, Frederick H.</creatorcontrib><creatorcontrib>Kramer, Christopher M.</creatorcontrib><creatorcontrib>Gan, Li-Ming</creatorcontrib><creatorcontrib>Salerno, Michael</creatorcontrib><title>Frequency of Coronary Microvascular Dysfunction and Diffuse Myocardial Fibrosis (Measured by Cardiovascular Magnetic Resonance) in Patients With Heart Failure and Preserved Left Ventricular Ejection Fraction</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Heart failure with preserved ejection fraction (HFpEF) is frequently accompanied by co-morbidities and a systemic proinflammatory state, resulting in coronary microvascular dysfunction (CMD), as well as myocardial fibrosis. The purpose of this study is to examine the relation between myocardial perfusion reserve (MPR) and diffuse myocardial fibrosis in patients with HFpEF using cardiovascular magnetic resonance. A single center study was performed in 19 patients with clinical HFpEF and 15 healthy control subjects who underwent quantitative first-pass perfusion imaging to calculate global MPR. T1 mapping was used to assess fibrosis and to calculate extracellular volume. Spiral cine displacement encoded stimulated echo was used to calculate myocardial strain. Comprehensive 2D echocardiograms with speckle tracking, cardiopulmonary exercise testing, and brain natriuretic peptide levels were also obtained. In patients with HFpEF, mean left ventricular EF was 61% ± 9% and left ventricular mass index 45 ± 12 g/m2. Compared with controls, HFpEF patients had reduced global MPR (2.29 ± 0.64 vs 3.38 ± 0.76, p = 0.002) and VO2 max (16.5 ± 6.8 vs 30.9 ± 7.7 ml/kg min, p <0.001) whereas extracellular volume (0.29 ± 0.04 vs 0.25 ± 0.04, p = 0.02), pulmonary artery systolic pressure (35.4 ± 13.7 vs 22.3 ± 5.4 mm Hg, p = 0.004), and average E/e’ (15.0 ± 7.6 vs 8.6 ± 2.0, p = 0.005) were increased. Displacement encoded stimulated echo peak systolic circumferential strain (p = 0.60) as well as echocardiographic derived global longitudinal strain (p = 0.07) were similar between both groups. The prevalence of CMD, defined as global MPR <2.5, in the HFpEF group was 69%. In conclusion, HFpEF patients have a high prevalence of CMD and diffuse fibrosis. These parameters may be useful clinical end points for future therapeutic trials.</description><subject>Adenosine</subject><subject>Age</subject><subject>Aged</subject><subject>Blood pressure</subject><subject>Brain natriuretic peptide</subject><subject>Cardiomyopathies - diagnosis</subject><subject>Cardiomyopathies - epidemiology</subject><subject>Cardiomyopathies - physiopathology</subject><subject>Cardiovascular disease</subject><subject>Clinical trials</subject><subject>Comorbidity</subject><subject>Congestive heart failure</subject><subject>Coronary Artery Disease - diagnosis</subject><subject>Coronary Artery Disease - epidemiology</subject><subject>Coronary Artery Disease - physiopathology</subject><subject>Coronary Circulation - physiology</subject><subject>Echocardiography</subject><subject>Ejection fraction</subject><subject>Female</subject><subject>Fibrosis</subject><subject>Fibrosis - diagnosis</subject><subject>Fibrosis - epidemiology</subject><subject>Fibrosis - physiopathology</subject><subject>Heart</subject><subject>Heart failure</subject><subject>Heart Failure - diagnosis</subject><subject>Heart Failure - epidemiology</subject><subject>Heart Failure - physiopathology</subject><subject>Heart rate</subject><subject>Heart Ventricles - diagnostic imaging</subject><subject>Heart Ventricles - physiopathology</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Incidence</subject><subject>Inflammation</subject><subject>Magnetic resonance</subject><subject>Magnetic Resonance Imaging, Cine - methods</subject><subject>Male</subject><subject>Mapping</subject><subject>Mathematical analysis</subject><subject>Mercury</subject><subject>Metabolism</subject><subject>Microcirculation - physiology</subject><subject>Microvasculature</subject><subject>Middle Aged</subject><subject>Myocardium - pathology</subject><subject>Neuroimaging</subject><subject>Oxygen consumption</subject><subject>Perfusion</subject><subject>Prevalence</subject><subject>Pulmonary arteries</subject><subject>Pulmonary artery</subject><subject>Resonance</subject><subject>Stroke Volume - physiology</subject><subject>Systolic pressure</subject><subject>Ultrasonic imaging</subject><subject>United States - epidemiology</subject><subject>Ventricle</subject><subject>Ventricular Function, Left</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkcFu1DAURS0EotPCJ4AssSmLDHYcJ_EKoWlDkWZEhSpYWo7zDI4ydrGTkfKV_FI9zQASG1a25fPufboXoVeUrCmh5bt-rfa9VqFb54SKNanXhNInaEXrSmRUUPYUrQgheSZoIc7QeYx9elLKy-fojFFe8SLnK_SrCfBzAqdn7A3e-OCdCjPeWR38QUU9DSrgqzmayenReoeV6_CVNWaKgHezP25g1YAb2wYfbcSXO1BxCtDhdsab4-9fnZ367mC0Gn-BmHychrfYOnyrRgtujPibHX_gG1BhxI2yQ1J5tLsNECEckuQWzIi_JjbYRfG6h2WtJqjHywv0zKghwsvTeYHumuu7zU22_fzx0-bDNtNFQcas1aaEikPbCQHamKJUjFUgOBOUG1C0ZLmoWK0oJ0XZ1onqDNesKAQzomQX6HKRvQ8-xRdHubdRwzAoB36KMmcp60pUVZ3QN_-gvZ-CS8slipK8ylklEsUXKuUeYwAj74PdpyokJfJYuOzlqXB5LFySWqY209zrk_rU7qH7M_W74QS8XwBIaRwsBBl1SltDZ0PKTnbe_sfiAdbpwuI</recordid><startdate>20191115</startdate><enddate>20191115</enddate><creator>Löffler, Adrián I.</creator><creator>Pan, Jonathan A.</creator><creator>Balfour, Pelbreton C.</creator><creator>Shaw, Peter W.</creator><creator>Yang, Yang</creator><creator>Nasir, Moiz</creator><creator>Auger, Daniel A.</creator><creator>Epstein, Frederick H.</creator><creator>Kramer, Christopher M.</creator><creator>Gan, Li-Ming</creator><creator>Salerno, Michael</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2841-4243</orcidid></search><sort><creationdate>20191115</creationdate><title>Frequency of Coronary Microvascular Dysfunction and Diffuse Myocardial Fibrosis (Measured by Cardiovascular Magnetic Resonance) in Patients With Heart Failure and Preserved Left Ventricular Ejection Fraction</title><author>Löffler, Adrián I. ; Pan, Jonathan A. ; Balfour, Pelbreton C. ; Shaw, Peter W. ; Yang, Yang ; Nasir, Moiz ; Auger, Daniel A. ; Epstein, Frederick H. ; Kramer, Christopher M. ; Gan, Li-Ming ; Salerno, Michael</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c440t-bcf6e75ebd99ecff46a337e953915fea16329738a15046b899edf5c34493f963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adenosine</topic><topic>Age</topic><topic>Aged</topic><topic>Blood pressure</topic><topic>Brain natriuretic peptide</topic><topic>Cardiomyopathies - diagnosis</topic><topic>Cardiomyopathies - epidemiology</topic><topic>Cardiomyopathies - physiopathology</topic><topic>Cardiovascular disease</topic><topic>Clinical trials</topic><topic>Comorbidity</topic><topic>Congestive heart failure</topic><topic>Coronary Artery Disease - diagnosis</topic><topic>Coronary Artery Disease - epidemiology</topic><topic>Coronary Artery Disease - physiopathology</topic><topic>Coronary Circulation - physiology</topic><topic>Echocardiography</topic><topic>Ejection fraction</topic><topic>Female</topic><topic>Fibrosis</topic><topic>Fibrosis - diagnosis</topic><topic>Fibrosis - epidemiology</topic><topic>Fibrosis - physiopathology</topic><topic>Heart</topic><topic>Heart failure</topic><topic>Heart Failure - diagnosis</topic><topic>Heart Failure - epidemiology</topic><topic>Heart Failure - physiopathology</topic><topic>Heart rate</topic><topic>Heart Ventricles - diagnostic imaging</topic><topic>Heart Ventricles - physiopathology</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Incidence</topic><topic>Inflammation</topic><topic>Magnetic resonance</topic><topic>Magnetic Resonance Imaging, Cine - methods</topic><topic>Male</topic><topic>Mapping</topic><topic>Mathematical analysis</topic><topic>Mercury</topic><topic>Metabolism</topic><topic>Microcirculation - physiology</topic><topic>Microvasculature</topic><topic>Middle Aged</topic><topic>Myocardium - pathology</topic><topic>Neuroimaging</topic><topic>Oxygen consumption</topic><topic>Perfusion</topic><topic>Prevalence</topic><topic>Pulmonary arteries</topic><topic>Pulmonary artery</topic><topic>Resonance</topic><topic>Stroke Volume - physiology</topic><topic>Systolic pressure</topic><topic>Ultrasonic imaging</topic><topic>United States - epidemiology</topic><topic>Ventricle</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Löffler, Adrián I.</creatorcontrib><creatorcontrib>Pan, Jonathan A.</creatorcontrib><creatorcontrib>Balfour, Pelbreton C.</creatorcontrib><creatorcontrib>Shaw, Peter W.</creatorcontrib><creatorcontrib>Yang, Yang</creatorcontrib><creatorcontrib>Nasir, Moiz</creatorcontrib><creatorcontrib>Auger, Daniel A.</creatorcontrib><creatorcontrib>Epstein, Frederick H.</creatorcontrib><creatorcontrib>Kramer, Christopher M.</creatorcontrib><creatorcontrib>Gan, Li-Ming</creatorcontrib><creatorcontrib>Salerno, Michael</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Biochemistry Abstracts 1</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Löffler, Adrián I.</au><au>Pan, Jonathan A.</au><au>Balfour, Pelbreton C.</au><au>Shaw, Peter W.</au><au>Yang, Yang</au><au>Nasir, Moiz</au><au>Auger, Daniel A.</au><au>Epstein, Frederick H.</au><au>Kramer, Christopher M.</au><au>Gan, Li-Ming</au><au>Salerno, Michael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Frequency of Coronary Microvascular Dysfunction and Diffuse Myocardial Fibrosis (Measured by Cardiovascular Magnetic Resonance) in Patients With Heart Failure and Preserved Left Ventricular Ejection Fraction</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2019-11-15</date><risdate>2019</risdate><volume>124</volume><issue>10</issue><spage>1584</spage><epage>1589</epage><pages>1584-1589</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><abstract>Heart failure with preserved ejection fraction (HFpEF) is frequently accompanied by co-morbidities and a systemic proinflammatory state, resulting in coronary microvascular dysfunction (CMD), as well as myocardial fibrosis. The purpose of this study is to examine the relation between myocardial perfusion reserve (MPR) and diffuse myocardial fibrosis in patients with HFpEF using cardiovascular magnetic resonance. A single center study was performed in 19 patients with clinical HFpEF and 15 healthy control subjects who underwent quantitative first-pass perfusion imaging to calculate global MPR. T1 mapping was used to assess fibrosis and to calculate extracellular volume. Spiral cine displacement encoded stimulated echo was used to calculate myocardial strain. Comprehensive 2D echocardiograms with speckle tracking, cardiopulmonary exercise testing, and brain natriuretic peptide levels were also obtained. In patients with HFpEF, mean left ventricular EF was 61% ± 9% and left ventricular mass index 45 ± 12 g/m2. Compared with controls, HFpEF patients had reduced global MPR (2.29 ± 0.64 vs 3.38 ± 0.76, p = 0.002) and VO2 max (16.5 ± 6.8 vs 30.9 ± 7.7 ml/kg min, p <0.001) whereas extracellular volume (0.29 ± 0.04 vs 0.25 ± 0.04, p = 0.02), pulmonary artery systolic pressure (35.4 ± 13.7 vs 22.3 ± 5.4 mm Hg, p = 0.004), and average E/e’ (15.0 ± 7.6 vs 8.6 ± 2.0, p = 0.005) were increased. Displacement encoded stimulated echo peak systolic circumferential strain (p = 0.60) as well as echocardiographic derived global longitudinal strain (p = 0.07) were similar between both groups. The prevalence of CMD, defined as global MPR <2.5, in the HFpEF group was 69%. In conclusion, HFpEF patients have a high prevalence of CMD and diffuse fibrosis. These parameters may be useful clinical end points for future therapeutic trials.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31575425</pmid><doi>10.1016/j.amjcard.2019.08.011</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-2841-4243</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-9149 |
| ispartof | The American journal of cardiology, 2019-11, Vol.124 (10), p.1584-1589 |
| issn | 0002-9149 1879-1913 |
| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adenosine Age Aged Blood pressure Brain natriuretic peptide Cardiomyopathies - diagnosis Cardiomyopathies - epidemiology Cardiomyopathies - physiopathology Cardiovascular disease Clinical trials Comorbidity Congestive heart failure Coronary Artery Disease - diagnosis Coronary Artery Disease - epidemiology Coronary Artery Disease - physiopathology Coronary Circulation - physiology Echocardiography Ejection fraction Female Fibrosis Fibrosis - diagnosis Fibrosis - epidemiology Fibrosis - physiopathology Heart Heart failure Heart Failure - diagnosis Heart Failure - epidemiology Heart Failure - physiopathology Heart rate Heart Ventricles - diagnostic imaging Heart Ventricles - physiopathology Humans Hypertension Incidence Inflammation Magnetic resonance Magnetic Resonance Imaging, Cine - methods Male Mapping Mathematical analysis Mercury Metabolism Microcirculation - physiology Microvasculature Middle Aged Myocardium - pathology Neuroimaging Oxygen consumption Perfusion Prevalence Pulmonary arteries Pulmonary artery Resonance Stroke Volume - physiology Systolic pressure Ultrasonic imaging United States - epidemiology Ventricle Ventricular Function, Left |
| title | Frequency of Coronary Microvascular Dysfunction and Diffuse Myocardial Fibrosis (Measured by Cardiovascular Magnetic Resonance) in Patients With Heart Failure and Preserved Left Ventricular Ejection Fraction |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-07T21%3A57%3A23IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Frequency%20of%20Coronary%20Microvascular%20Dysfunction%20and%20Diffuse%20Myocardial%20Fibrosis%20(Measured%20by%20Cardiovascular%20Magnetic%20Resonance)%20in%20Patients%20With%20Heart%20Failure%20and%20Preserved%20Left%20Ventricular%20Ejection%20Fraction&rft.jtitle=The%20American%20journal%20of%20cardiology&rft.au=L%C3%B6ffler,%20Adri%C3%A1n%20I.&rft.date=2019-11-15&rft.volume=124&rft.issue=10&rft.spage=1584&rft.epage=1589&rft.pages=1584-1589&rft.issn=0002-9149&rft.eissn=1879-1913&rft_id=info:doi/10.1016/j.amjcard.2019.08.011&rft_dat=%3Cproquest_cross%3E2310272379%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2310272379&rft_id=info:pmid/31575425&rft_els_id=S0002914919309506&rfr_iscdi=true |