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Myocardial Energetics in Heart Failure With Preserved Ejection Fraction.

Publication ,  Journal Article
AbouEzzeddine, OF; Kemp, BJ; Borlaug, BA; Mullan, BP; Behfar, A; Pislaru, SV; Fudim, M; Redfield, MM; Chareonthaitawee, P
Published in: Circ Heart Fail
October 2019

BACKGROUND: The role of coronary microvascular disease and its impact on functional and energetic reserve in heart failure with preserved ejection fraction (HFpEF) remains unclear. We hypothesized that in response to submaximal pharmacologic stress (dobutamine), patients with HFpEF have impairment in left ventricular (LV) myocardial mechanical (external work [EW]), energetic (myocardial O2 consumption [MVO2]), and myocardial blood flow (MBF) reserve. We further assessed whether coupling of MBF to EW is impaired in HFpEF and associated with compensatory increases or pathological decreases in myocardial O2 extraction. Lastly, we assessed whether coupling of MVO2 to EW (mechanical efficiency) was impaired in HFpEF. METHODS AND RESULTS: In prospectively enrolled patients with HFpEF (n=19) and age/sex-matched healthy controls (n=19), we performed 11C-acetate positron emission tomography assessing MVO2 and MBF at rest and during dobutamine infusion. EW was calculated as stroke volume (echo)×end-systolic pressure×heart rate. At rest, compared with controls, patients with HFpEF had higher LV EW, MVO2, and MBF. With dobutamine, LV EW, MVO2, and MBF increased in both HFpEF and controls; however, the magnitude of increases was significantly smaller in HFpEF. In both groups, MBF increased in relation to EW, but in HFpEF, the slope of the relationship was significantly smaller than in controls. Myocardial O2 extraction was increased in HFpEF. Mechanical efficiency was similar in HFpEF and controls. In a post hoc analysis, HFpEF patients with LV hypertrophy (n=10) had significant reductions in LV mechanical efficiency relative to controls. CONCLUSIONS: In HFpEF during submaximal dobutamine stress, there is myocardial mechanical-, energetic- and flow-reserve dysfunction with impaired coupling of blood flow to demand and slight increases in myocardial O2 extraction. These findings provide evidence that coronary microvascular dysfunction is present in HFpEF, limits O2 supply relative to demand, and is associated with reserve dysfunction.

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Published In

Circ Heart Fail

DOI

EISSN

1941-3297

Publication Date

October 2019

Volume

12

Issue

10

Start / End Page

e006240

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Stroke Volume
  • Prospective Studies
  • Positron-Emission Tomography
  • Oxygen Consumption
  • Myocardium
  • Middle Aged
  • Microcirculation
  • Male
  • Humans
 

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AbouEzzeddine, O. F., Kemp, B. J., Borlaug, B. A., Mullan, B. P., Behfar, A., Pislaru, S. V., … Chareonthaitawee, P. (2019). Myocardial Energetics in Heart Failure With Preserved Ejection Fraction. Circ Heart Fail, 12(10), e006240. https://doi.org/10.1161/CIRCHEARTFAILURE.119.006240
AbouEzzeddine, Omar F., Bradley J. Kemp, Barry A. Borlaug, Brian P. Mullan, Atta Behfar, Sorin V. Pislaru, Marat Fudim, Margaret M. Redfield, and Panithaya Chareonthaitawee. “Myocardial Energetics in Heart Failure With Preserved Ejection Fraction.Circ Heart Fail 12, no. 10 (October 2019): e006240. https://doi.org/10.1161/CIRCHEARTFAILURE.119.006240.
AbouEzzeddine OF, Kemp BJ, Borlaug BA, Mullan BP, Behfar A, Pislaru SV, et al. Myocardial Energetics in Heart Failure With Preserved Ejection Fraction. Circ Heart Fail. 2019 Oct;12(10):e006240.
AbouEzzeddine, Omar F., et al. “Myocardial Energetics in Heart Failure With Preserved Ejection Fraction.Circ Heart Fail, vol. 12, no. 10, Oct. 2019, p. e006240. Pubmed, doi:10.1161/CIRCHEARTFAILURE.119.006240.
AbouEzzeddine OF, Kemp BJ, Borlaug BA, Mullan BP, Behfar A, Pislaru SV, Fudim M, Redfield MM, Chareonthaitawee P. Myocardial Energetics in Heart Failure With Preserved Ejection Fraction. Circ Heart Fail. 2019 Oct;12(10):e006240.

Published In

Circ Heart Fail

DOI

EISSN

1941-3297

Publication Date

October 2019

Volume

12

Issue

10

Start / End Page

e006240

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Stroke Volume
  • Prospective Studies
  • Positron-Emission Tomography
  • Oxygen Consumption
  • Myocardium
  • Middle Aged
  • Microcirculation
  • Male
  • Humans