2021/12 - Cardiovascular magnetic resonance assessment of coronary flow reserve improves risk stratification in heart failure with preserved ejection fraction [Journal Club]-Webinar

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This retrospective study examined whether coronary flow reserve (CFR) measured by phase-contrast cine cardiovascular magnetic resonance (CMR) can predict outcomes in patients with heart failure with preserved ejection fraction (HFpEF). The investigators analyzed 163 HFpEF patients who underwent stress CMR, including coronary sinus flow measurement, perfusion imaging, and late gadolinium enhancement (LGE).<br /><br />CFR was calculated from myocardial blood flow at rest and during adenosine triphosphate stress. Over a median follow-up of 4.1 years, 26 patients (16%) experienced adverse events, defined as death from any cause or hospitalization for worsening heart failure. Patients with adverse events had significantly lower CFR than those without events (1.93 vs. 2.67). A CFR cutoff of 2.0 identified a group with a much higher event rate. CFR also predicted events better than LGE burden and global longitudinal strain (GLS), based on receiver operating characteristic analysis.<br /><br />The study found that lower CFR was associated with worse myocardial and right ventricular strain measures, higher BNP levels, and greater LGE, suggesting links among coronary microvascular dysfunction, myocardial fibrosis, and cardiac dysfunction. No patients showed ischemia on stress perfusion imaging, indicating CFR likely reflected microvascular impairment rather than obstructive coronary artery disease.<br /><br />The authors conclude that CMR-derived CFR is a useful non-invasive prognostic marker in HFpEF and may improve risk stratification. They note advantages of this technique, including no radiation and the possibility of repeated measurements for monitoring disease progression or treatment response. Limitations include the single-center retrospective design and relatively small sample size.

Keywords

heart failure with preserved ejection fraction

coronary flow reserve

cardiovascular magnetic resonance

phase-contrast cine CMR

coronary microvascular dysfunction

stress perfusion imaging

late gadolinium enhancement

global longitudinal strain

prognostic marker

risk stratification