Coronary Microvascular Dysfunction Is Associated With Early Heart Failure With Preserved Ejection Fraction Elicited by Exercise Hemodynamic Testing

Heart failure with preserved ejection fraction (HFpEF) represents a major diagnotic and therapeutic challenge. Overlapping clinical characteristics suggest there may be common pathophysiologic mechanisms that link the syndromes of coronary microvascular dysfunction (CMD) and HFpEF.1 While a high prevalence of CMD is established in patients with overt HFpEF,2 whether CMD among patients with ischemia and non-obstructive coronary arteries (INOCA) may be a precursor to HFpEF is not clear. To evaluate this possibility, we conducted a retrospective multicenter analysis of INOCA patients who underwent intracoronary physiology testing followed by exercise right heart catheterization.