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The prevalence of coronary microvascular dysfunction (CMD) in heart failure with preserved ejection fraction (HFpEF): a systematic review and meta-analysis

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Abstract

To date, studies on the prevalence of coronary microvascular dysfunction (CMD) in heart failure with preserved ejection fraction (HFpEF) have not been summarized and analyzed as a whole. We conducted this systematic review and meta-analysis to assess the prevalence of CMD in patients with HFpEF. The PubMed, Cochrane, and Embase databases were searched from dates of inception until May 1, 2023. The primary outcome was the prevalence of CMD in patients with HFpEF, and values of CMD prevalence were pooled using a random-effects model. In total, 10 studies involving 1267 patients, including 822 with HFpEF and 445 without HFpEF, were included. The pooled prevalence of CMD in patients with HFpEF was 71% (95% CI, 0.63–0.79). In the subgroup analysis, the prevalence of CMD was 79% (95% CI, 0.71–0.87) by invasive measurement and 66% (95% CI, 0.54–0.77) by noninvasive measurement and 67% (95% CI, 0.52–0.82) with CFR < 2.0 and 75.0% (95% CI, 0.71–0.79) with CFR < 2.5. The prevalence of endothelium-independent CMD and endothelium-dependent CMD was 62% (95% CI, 0.53–0.72) and 50% (95% CI, 0.19–0.81), respectively. The prevalence of CMD was 74% (95% CI = 0.69–0.79) and 66% (95% CI = 0.41–0.90) in prospective and retrospective studies, respectively. Compared with the control group, patients with HFpEF had a significantly lower CFR (MD =  − 1.28, 95% CI =  − 1.82 to − 0.74, P < 0.01) and a higher prevalence of CMD (RR = 2.21, 95% CI = 1.52 to 3.20, P < 0.01). Qualitative analysis demonstrated that CMD might be associated with poor clinical outcomes in patients with HFpEF. In conclusion, this is the first systematic review and meta-analysis of all studies reporting the prevalence of CMD in patients with HFpEF. Our study demonstrates that CMD is common in patients with HFpEF and might be associated with poor clinical outcomes in these patients. Clinicians should attach importance to CMD in the diagnosis and treatment of HFpEF. The number of studies in this field is relatively small. Therefore, more high-quality studies are needed to explore the diagnostic and prognostic value of CMD and the potential role of CMD as a therapeutic target in patients with HFpEF.

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Availability of data and materials

The data that support the findings of this study are available from the corresponding author.

Abbreviations

CMD:

Coronary microvascular dysfunction

HFpEF:

Heart failure with preserved ejection fraction

HF:

Heart failure

ACS:

Acute coronary syndromes

LV:

Left ventricular

RAS:

Renin-angiotensin system

MPR:

Myocardial perfusion reserve

CFVR:

Coronary flow velocity reserve

MFR:

Myocardial flow reserve

MBFR:

Myocardial blood flow reserve

CFR:

Coronary flow reserve

MACE:

Major adverse cardiovascular events

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Funding

This research was funded by Hangzhou Medical and Health Technology Project (Number Z20210019), Hangzhou Medical and Health Science and Technology Project (No. OO20190131), and Hangzhou Science and Technology Development Plan (Number 20201203B178).

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  1. Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310030, China

    Xiaoxiao Lin, Guomin Wu, Shuai Wang & Jinyu Huang

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XL: data extraction, statistical analysis, risk of bias, manuscript preparation. SW: generated the idea, data extraction, statistical analysis, risk of bias, manuscript preparation. GW: revise manuscript. JH: generated the idea, data extraction, statistical analysis, risk of bias, manuscript preparation.

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Lin, X., Wu, G., Wang, S. et al. The prevalence of coronary microvascular dysfunction (CMD) in heart failure with preserved ejection fraction (HFpEF): a systematic review and meta-analysis. Heart Fail Rev 29, 405–416 (2024). https://doi.org/10.1007/s10741-023-10362-x

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