SEX BUT NOT EJECTION FRACTION INFLUENCES MYOCARDIAL PERFUSION AND DETECTION OF MICROVASCULAR DISEASE IN PATIENTS WITH NON-ISCHEMIC HEART FAILURE (RF_TH_268)

Thursday, January 30, 2025

6:00 PM – 6:10 PM East Coast USA Time

Location: Blue Room PreFunction

Presenting Author(s)

KD

Kristian Dimovski, MD

MD
Lund University and Skåne University Hospital, Lund, Sweden, Sweden

Primary Author(s)

KD

Kristian Dimovski, MD

MD
Lund University and Skåne University Hospital, Lund, Sweden, Sweden

Co-Author(s)

AN

Anders Nelsson, MD

MD, PhD Student
Lund University and Skåne University Hospital, Lund, Sweden, Sweden
Ellen Ostenfeld, MD, PhD

MD, PhD, Associate professor
Lund University and Skåne University Hospital, Lund, Sweden, Sweden
RJ

Robert Jablonowski, MD, PhD

MD, PhD
Lund University, Sweden
PK

Peter Kellman, PhD

Director of the Medical Signal and Image Processing Program
National Heart, Lung, and Blood Institute, National Institutes of Health
JS

J. Gustav Smith, MD, PhD

Professor, medical doctor
The Wallenberg Laboratory/Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University and the Department of Cardiology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden, Sweden
MM

Martin Magnusson, MD, PhD

Professor
Lund University, Skåne University Hospital, Sweden
Henrik Engblom, MD, PhD

Professor, MD
Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden, Sweden
HA

Håkan Arheden, MD, PhD

MD, PhD, Professor
Lund University and Skåne University Hospital, Lund, Sweden, Sweden
Marcus Carlsson, MD, PhD

Professor
Lund University and Skåne University Hospital, Lund, Sweden, Sweden

Background: Prior PET and invasive angiography studies have shown that patients with heart failure (HF) of non-ischemic etiology commonly have microvascular dysfunction (MVD), and that the MVD is of prognostic relevance¹. However, there is limited data using quantitative first pass perfusion (qFPP) CMR in HF. Therefore, we aimed to determine how MVD relates to myocardial perfusion (MP), global LV function, sex and risk factors of MVD in HF using CMR.

Methods: Sixty-one HF patients without coronary artery disease or infiltrative etiology (24 HFrEF, 21 HFmrEF and 16 HFpEF) and 26 healthy controls were prospectively included and underwent CMR using a research sequence on a 1.5T MAGNETOM Sola or Aera (Siemens Healthineers, Germany). Quantitative short-axis perfusion maps (basal, mid, and apical) were acquired using single bolus (0.05 mmol/kg), dual sequence perfusion imaging² at rest and during pharmacological stress using adenosine vasodilation. Myocardial perfusion reserve (MPR) was defined as the ratio between stress and rest MP. MVD was defined as 1) MPR < 2.19³ (MVD_MPR) or 2) absolute perfusion during vasodilation < 2.25 ml/min/g⁴ (MVD_ABS).

Results:

Twenty-two HF patients (39%) had MVD_MPR and twenty-six HF patients (44%) had MVD_ABS.Eighteen patients (32%) had combined MVD_MPRand MVD_ABS. MPR was lower in HF patients compared to healthy controls (HFrEF 2.8±0.7 vs 3.8±1.2, p=0.001; HFmrEF 2.2±0.6 vs 3.8±1.2, p< 0.001 and HFpEF 2.7±1.0 vs 3.8±1.2, p=0.002; Figure 1). Myocardial perfusion at stress was lower in HF patients compared healthy controls (HFrEF 2.4 ±0.6 vs 3.4±0.8, p< 0.001; HFmrEF 2.0±0.6 vs 3.4±0.8, p< 0.001; HFpEF 2.6±0.7 vs 3.4±0.8, p< 0.001; Figure 1) but with no difference in perfusion between the HF cohorts. There was no significant correlation between EF and MPR (r=0.11, p=0.42), MP at stress (r=0.07, p=0.59) or MP at rest (r=0.23, p=0.08) in HF patients.

Female HF patients had higher myocardial perfusion at rest and stress compared to male HF patients (rest 1.0±0.2 vs 0.9± 0.2, p=0.021; stress 2.5±0.5 vs 2.1±0.7, p=0.008) (Figure 2). MPR did not differ between female and male HF patients (p=0.905). There was no difference in perfusion between hypertensive (n=35) and normotensive HF patients (rest p=0.214; stress p=0.968) or between HF patients with diabetes (n=12) and without diabetes (rest p=0.402; stress p=0.755). Multivariate regression analysis including age confirmed these results (Table 1).

Conclusion: Microvascular dysfunction is present in almost half of non-ischemic HF independent of EF. Female sex was associated with a higher myocardial perfusion than males across all groups of heart failure similar to results in healthy controls⁵, while there was no difference in MPR. Different cutoffs for males and females to detect MVD should be considered when using absolute perfusion. CMR with qFPP has potential in future HF trials of MVD to select patients with MVD.