{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:01:46Z","timestamp":1791259306076,"version":"4.1.0"},"reference-count":30,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Swedish government"},{"name":"ALF","award":["ALFGBG-942775"],"award-info":[{"award-number":["ALFGBG-942775"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2025,8,14]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>We investigated the prevalence of coronary microvascular dysfunction (CMD) and its association with severity of heart failure in patients with reduced or mildly reduced ejection fraction (HFrEF and HFmrEF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Patients with stable, symptomatic heart failure with left ventricular ejection fraction (LVEF) &lt;50% were enrolled. Data collection included physical examination, blood samples, Kansas City Cardiomyopathy Questionnaire (KCCQ), carotid to femoral pulse wave velocity, echocardiography and adenosine-based transthoracic Doppler echocardiography to assess coronary flow reserve (CFR). A CFR &lt;2.5 was used to diagnose CMD. Adjusted multivariable linear regression analysis with CFR as the dependent variable and adjusted multivariate logistic regression with CMD as the dependent variable were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 125 patients were included, of whom 99 (79%) were men. The overall mean age is 73.4 (\u00b17.5) years. In patients eligible for CFR (n=68, 54%), CMD was present in 45 (66%). Patients with CMD had higher N-terminal pro B-type natriuretic peptide (NTproBNP), hsTroponin-T, lower KCCQ score, lower left and right ventricular and left atrial global longitudinal strain (GLS) (p&lt;0.05). In multivariable linear regression, lower CFR was independently associated with reduced GLS, higher NTproBNP and hsTroponin-T. Furthermore, in adjusted logistic regression analysis, lower LVEF, reduced right ventricular GLS and higher biomarkers were independently associated with an increased risk of CMD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CMD was present in 66% of patients with chronic heart failure and HFrEF or HFmrEF. Markers of more severe heart failure, including reduced GLS and higher NTproBNP and hsTroponin-T, were independently associated with lower CFR. Reduced right ventricular GLS and higher levels of the biomarkers were also independently associated with CMD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003509","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T13:30:14Z","timestamp":1757079014000},"page":"e003509","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Prevalence and importance of coronary microvascular dysfunction in patients with heart failure and reduced or mildly reduced ejection fraction"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2135-2578","authenticated-orcid":false,"given":"Charlotte","family":"Nordberg Backelin","sequence":"first","affiliation":[{"name":"Cardiology Department, Sahlgrenska University Hospital, Gothenburg, Sweden"},{"name":"Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Svedlund","sequence":"additional","affiliation":[{"name":"Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Entela","family":"Bollano","sequence":"additional","affiliation":[{"name":"Cardiology Department, Sahlgrenska University Hospital, Gothenburg, Sweden"},{"name":"Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Hjalmarsson","sequence":"additional","affiliation":[{"name":"Cardiology Department, Sahlgrenska University Hospital, Gothenburg, Sweden"},{"name":"Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 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