Left ventricular end-diastolic pressure in women with ischemia and no obstructive coronary artery disease: The women's ischemia syndrome evaluation – Coronary microvascular dysfunction study (WISE-CVD)

INTRODUCTION: Coronary microvascular dysfunction (CMD) has been proposed as a pathophysiological contributor to heart failure with preserved ejection fraction (HFpEF). Elevated left ventricular end-diastolic pressure (LVEDP) is often present in patients with CMD. HYPOTHESIS: We hypothesized that CMD-mediated impairment in LV relaxation may contribute to elevated LVEDP. METHODS: Women (n = 253) with signs and symptoms of ischemia and no obstructive coronary artery disease (INOCA) underwent invasive coronary functional testing (CFT) for measurement of resting LVEDP and coronary microvascular function. A pre-defined sequential subset of these women underwent cardiac MRI (CMRI). Two sample t-test, Fisher's exact test and Spearman correlation were performed. RESULTS: Group mean LVEDP was 14.4 ± 5.0 mmHg, with 150 women (59%) having LVEDP >12 mmHg. LVEDP directly related with body mass index (BMI) (r = 0.324, p < 0.001), and systolic blood pressure (r = 0.176, p = 0.01) at time of CFT, as well as time to peak filling rate (r = 0.13, p = 0.050). There were no relationships between LVEDP and invasive or non-invasive measures of CMD. CONCLUSIONS: Among women with suspected CMD, elevated resting LVEDP is associated with higher BMI and systolic blood pressure. There were no significant associations between LVEDP and measurements of CMD. Further analyses are needed to further evaluate LVEDP, CMD and development of HFpEF.