Modeling heart failure with preserved ejection fraction (HFpEF) likelihood among women with suspected coronary microvascular dysfunction (CMD)

Background Coronary microvascular dysfunction (CMD) can precede development of heart failure with preserved ejection fraction (HFpEF) in patients with ischemia and no obstructive coronary arteries (INOCA). The H2FPEF score is used to estimate HFpEF likelihood but has not been evaluated among women with suspected INOCA. Methods Women ( n = 98) with suspected INOCA enrolled in prospective cohort studies at a single center with both cardiac magnetic resonance imaging (CMR) and echocardiography to calculate H2FPEF score. CMR evaluated left ventricular (LV) structure, function, myocardial perfusion reserve index (MPRI) and fibrosis. Spearman correlation and multivariable linear regression were performed. Results Group mean age was 56 years, BMI 27 kg/m 2 , 39% had hypertension, and 12% had diabetes. Median H2FPEF score was 2 (range 0–7), with 43 (44%), 53 (54%), and 2 (2%) ranked as having low (0–1), intermediate (2–5), or high (6–9) probability of HFpEF, respectively. H2FPEF score was inversely related to MPRI, native T1, extracellular volume, and Seattle Angina Questionnaire (SAQ) physical limitation score (all p < 0.05), but not related to LV strain or remodeling. Regression modeling demonstrated that low MPRI, SAQ physical limitation, and diabetes were independent predictors of H2FPEF, adjusted for dyslipidemia and native T1. Conclusions Among women with suspected INOCA, 54% had an intermediate or higher H2FPEF score. Compromised microvascular perfusion, fibrosis, angina, and history of diabetes predicted H2FPEF score. These findings support the hypothesis that CMD may contribute to development of HFpEF in women with INOCA. Longitudinal studies and intervention trials are needed.