Progression of coronary microvascular dysfunction to heart failure with preserved ejection fraction: a case report

Sandy Joung, Janet Wei, Michael D Nelson, Haider Aldiwani, Chrisandra Shufelt, Balaji Tamarappoo, Daniel Berman, Louise E J Thomson, C Noel Bairey Merz, Sandy Joung, Janet Wei, Michael D Nelson, Haider Aldiwani, Chrisandra Shufelt, Balaji Tamarappoo, Daniel Berman, Louise E J Thomson, C Noel Bairey Merz

Abstract

Background: In women with evidence of ischemia and no obstructive coronary artery disease the underlying mechanism is most often attributed to coronary microvascular dysfunction. Higher rates of adverse cardiovascular events, specifically heart failure with preserved ejection fraction, are present in women with coronary microvascular dysfunction, leading to the hypothesis that coronary microvascular dysfunction may contribute to the progression of heart failure with preserved ejection fraction. A 55-year-old, Caucasian woman with a past medical history of chest pain and shortness of breath was referred to our tertiary care center and diagnosed as having coronary microvascular dysfunction by invasive coronary reactivity testing. After 10 years of follow-up care for coronary microvascular dysfunction, she presented to an emergency room in acute heart failure and was diagnosed as having heart failure with preserved ejection fraction.

Discussion: The current case report provides a specific example in support of existing studies that demonstrate that coronary microvascular dysfunction may be a precursor of heart failure with preserved ejection fraction. Further research is needed to establish causality and management.

Trial registration: Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02582021 .

Keywords: Cardiac magnetic resonance imaging; Coronary microvascular dysfunction; Heart failure with preserved ejection fraction; Non-obstructive coronary artery disease.

Conflict of interest statement

Ethics approval and consent to participate

All studies have been approved by Cedars-Sinai Medical Center’s Institutional Review Board (IRB).

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Baseline (a, b) and 10-year follow-up (c, d) adenosine stress first-pass perfusion cardiac magnetic resonance imaging showing evidence of circumferential subendocardial hypoperfusion at stress, consistent with coronary microvascular dysfunction-related ischemia. Myocardial perfusion reserve index decreased from 1.8 to 1.1 over 10-year period, indicating worsened ischemia

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