Coronary Microvascular Rarefaction and Myocardial Fibrosis in Heart Failure with Preserved Ejection Fraction
Heart failure with preserved ejection fraction (HFpEF) is common and increasing in prevalence. HFpEF occurs in association with advanced age and cardiovascular, metabolic and pro-inflammatory comorbidities. Characterization of myocardial structural changes in heart failure with preserved ejection fraction (HFpEF) has been hindered by limited availability of human cardiac tissue.
Mayo Clinic researchers, first author Selma Mohammed, M.B.B.S., conducted a study in Circulation to test the hypothesis that cardiac hypertrophy, microvascular rarefaction and myocardial fibrosis are common and related in patients with HFpEF. For the study, they identified HFpEF patients and age-appropriate control patients (non-cardiac death, no HF diagnosis) who underwent autopsy.
According to the results, subjects with HFpEF had heavier hearts, more severe coronary artery disease (CAD), more left ventricular (LV) fibrosis, and lower microvascular density (MVD) than control. Further, myocardial fibrosis increased with decreasing MVD in controls and HFpEF. Heart weight, fibrosis, and MVD were similar in HFpEF patients with versus without CAD.
Based on these results, patients with HFpEF had more cardiac hypertrophy, epicardial CAD, coronary microvascular rarefaction, and myocardial fibrosis than controls. Each of these findings may contribute to the LV diastolic dysfunction and cardiac reserve function impairment characteristic of HFpEF.
Additional Mayo Clinic authors include: Saad Hussain, M.B.B.S., Sultan Mirzoyev, M.D., William Edwards, M.D., Joseph Maleszewski, M.D., and Margaret Redfield, M.D.