title: Impairment of Coronary Flow Reserve Evaluated by Phase Contrast Cine-Magnetic Resonance Imaging in Patients With Heart Failure With Preserved Ejection Fraction.
abstract: BACKGROUND
  Phase contrast (PC) cine-magnetic resonance imaging (MRI) of the coronary sinus allows for noninvasive evaluation of coronary flow reserve (CFR), which is an index of left ventricular microvascular function. The objective of this study was to investigate coronary flow reserve in patients with heart failure with preserved ejection fraction (HFpEF).
  
  
  RESULTS
  We studied 25 patients with HFpEF (mean and SD of age: 73±7 years), 13 with hypertensive left ventricular hypertrophy (LVH) (67±10 years), and 18 controls (65±15 years). Breath-hold PC cine-MRI images of the coronary sinus were obtained to assess blood flow at rest and during ATP infusion. CFR was calculated as coronary sinus blood flow during ATP infusion divided by coronary sinus blood flow at rest. Impairment of CFR was defined as CFR <2.5 according to a previous study. The majority (76%) of HFpEF patients had decreased CFR. CFR was significantly decreased in HFpEF patients in comparison to hypertensive LVH patients and control subjects (CFR: 2.21±0.55 in HFpEF vs 3.05±0.74 in hypertensive LVH, 3.83±0.73 in controls; P<0.001 by 1-way ANOVA). According to multivariable linear regression analysis, CFR independently and significantly correlated with serum brain natriuretic peptide level (β=-68.0; 95% CI, -116.2 to -19.7; P=0.007).
  
  
  CONCLUSIONS
  CFR was significantly lower in patients with HFpEF than in hypertensive LVH patients and controls. These results indicated that impairment of CFR might be a pathophysiological factor for HFpEF and might be related to HFpEF disease severity.
authors.affiliation: Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, MA shingo.m12226@gmail.com.
authors.forename: Shingo
authors.initials: S
authors.lastname: Kato
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan.
authors.forename: Naka
authors.initials: N
authors.lastname: Saito
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan.
authors.forename: Hidekuni
authors.initials: H
authors.lastname: Kirigaya
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan.
authors.forename: Daiki
authors.initials: D
authors.lastname: Gyotoku
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Iinuma
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Kusakawa
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Iguchi
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nakachi
authors.affiliation: Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Fukui
authors.affiliation: Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Futaki
authors.affiliation: Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan.
authors.forename: Tae
authors.initials: T
authors.lastname: Iwasawa
authors.affiliation: Department of Cardiology, Yokohama City Medical Center, Yokohama, Kanagawa, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Medical Science and Cardiorenal Medicine, Yokohama City University Hospital, Yokohama, Kanagawa, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Umemura
mesh_terms: D000255:Adenosine Triphosphate / Q000008:administration & dosage; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity; D062485:Breath Holding; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D054326:Coronary Sinus / Q000503:physiopathology*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000503:physiopathology; D016014:Linear Models; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D015999:Multivariate Analysis; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012039:Regional Blood Flow; D012720:Severity of Illness Index; D013318:Stroke Volume; D014665:Vasodilator Agents / Q000008:administration & dosage; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D014665:Vasodilator Agents; D020097:Natriuretic Peptide, Brain; D000255:Adenosine Triphosphate
keywords: coronary flow reserve; heart failure with preserved ejection fraction; hypertension; left ventricular hypertrophy