Prognostic Significance of Coronary Microvascular Dysfunction in Patients With Heart Failure With Preserved Ejection Fraction

The prognostic impact of coronary microvascular dysfunction (CMD) has been scarcely addressed in heart failure with preserved ejection fraction (HFpEF). This study investigated the prevalence and prognostic significance of CMD as measured by a novel pressure wire–free coronary angiography–derived index of microcirculatory resistance (caIMR) on clinical outcomes. Patients diagnosed with HFpEF from 2019 to 2021 were enrolled retrospectively. caIMR was used to quantify microvascular function, and patients were categorised into 2 groups based on their caIMR. The primary end points were composite of all-cause death and heart failure rehospitalisation. Of 137 HFpEF patients, CMD (defined as caIMR ≥ 25) was present in 88 patients (64.2%). Forty-five patients (32.8%) experienced composite events during a mean follow-up of 15 months. Compared with patients with caIMR < 25, those with caIMR ≥ 25 had a notably higher incidence of composite events (16.3% vs 42.0%; P = 0.002). On survival analysis, patients with caIMR ≥ 25 demonstrated a worse prognosis than those with caIMR < 25 for composite events (P = 0.006). Patients with caIMR ≥ 25 in multiple coronary arteries showed a trend to worse outcome than those with caIMR ≥ 25 in a single coronary artery (log-rank P = 0.056). In adjusted analysis, caIMR ≥ 25 was independently predictive of adverse outcomes (adjusted hazard ratio 2.93, 95% confidence interval [CI] 1.28-6.70; P = 0.010). caIMR displayed a significant predictive power for adverse event prediction (area under the receiver operating characteristic curve 0.767, 95% CI 0.677-0.858; P < 0.001). CMD is highly prevalent and is an independent predictor of adverse outcomes in HFpEF patients. Assessment of CMD may identify high-risk patients early for intensified treatment and risk-factor management. La signification pronostique de la dysfonction microvasculaire coronaire (DMC) a fait l’objet d’un nombre limité d’études dans le contexte de l’insuffisance cardiaque avec fraction d’éjection préservée (ICFEP). Cette étude a examiné la prévalence et la signification pronostique de la DMC sur les résultats cliniques, à l’aide d’un nouvel indice de résistance microcirculatoire mesuré par angiographie coronarienne sans cathéter (caIMR). Les patients ayant reçu un diagnostic d’ICFEP entre 2019 et 2021 ont été recrutés de manière rétrospective. Le caIMR a été employé pour mesurer la fonction microvasculaire, et les patients ont été classés en deux groupes en fonction de leur