{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T15:27:50Z","timestamp":1790954870978,"version":"4.1.0"},"reference-count":47,"publisher":"American Physiological Society","issue":"5","funder":[{"DOI":"10.13039\/100000968","name":"American Heart Association (AHA)","doi-asserted-by":"publisher","award":["14SDG20380354"],"award-info":[{"award-number":["14SDG20380354"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NIH NIDDK","award":["T35DK062719-29"],"award-info":[{"award-number":["T35DK062719-29"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["American Journal of Physiology-Heart and Circulatory Physiology"],"published-print":{"date-parts":[[2018,5,1]]},"abstract":"<jats:p> There are multiple proposed mechanisms for the pathophysiology of heart failure (HF) with preserved ejection fraction (HFpEF). We hypothesized that coronary microvascular dysfunction is common in these patients. In a prospective, observational study, patients undergoing cardiac catheterization with HFpEF [left ventricular (LV) ejection fraction \u2265 50% and with clinical HF] were compared with similar patients without HFpEF. Patients with \u226550% stenosis were excluded, and coronary flow reserve (CFR) and the index of microvascular resistance (IMR) were measured after adenosine administration using a guidewire, with CFR \u2264 2 and IMR \u2265 23 being abnormal. Baseline characteristics and CFR and IMR were compared in 30 HFpEF patients and 14 control subjects. Compared with control subjects, HFpEF patients were older (65.4\u2009\u00b1 9.6 vs. 55.1\u2009\u00b1 3.1 yr, P &lt; 0.01), had higher numbers of comorbidities (4.4\u2009\u00b1 1.5 vs. 2.6\u2009\u00b1 1.9, P = 0.002), had higher median B-type natriuretic peptide [161 (interquartile range: 75\u2013511) pg\/dl vs. 37 (interquartile range: 18.5\u2013111) pg\/dl, P &lt; 0.01], and had higher LV end-diastolic pressure (17.8\u2009\u00b1 4.2 vs. 8.4\u2009\u00b1 4.2, P &lt; 0.01). HFpEF patients had lower CFR (2.55\u2009\u00b1 1.60 vs. 3.84\u2009\u00b1 1.89, P = 0.024) and higher IMR (26.7\u2009\u00b1 10.3 vs. 19.7\u2009\u00b1 9.7 units, P = 0.037) than control subjects. Most (71.4%) control subjects had normal coronary physiology, whereas 36.7% of HFpEF patients had both abnormal CFR and IMR and another 36.7% had either abnormal CFR or IMR. In conclusion, this is the first study that has reported invasively determined CFR and IMR in HFpEF patients. We demonstrated the presence of four distinct coronary physiology groups in HFpEF patients. Investigation into the potential mechanisms for these findings is needed. <\/jats:p><jats:p> NEW &amp; NOTEWORTHY In this prospective observational study of patients with heart failure with preserved ejection fraction (HFpEF), we found that patients with HFpEF had more abnormalities of coronary flow and resistance than asymptomatic control patients, indicating that coronary microvascular dysfunction may play a role in the HFpEF disease process. <\/jats:p>","DOI":"10.1152\/ajpheart.00680.2017","type":"journal-article","created":{"date-parts":[[2018,2,9]],"date-time":"2018-02-09T09:42:16Z","timestamp":1518169336000},"page":"H1033-H1042","source":"Crossref","is-referenced-by-count":136,"title":["Coronary microvascular dysfunction in patients with heart failure with preserved ejection fraction"],"prefix":"10.1152","volume":"314","author":[{"given":"Kathryn","family":"Dryer","sequence":"first","affiliation":[{"name":"Section of Cardiology, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Gajjar","sequence":"additional","affiliation":[{"name":"Advocate Healthcare, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikhil","family":"Narang","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Lee","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Paul","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atman P.","family":"Shah","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandeep","family":"Nathan","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javed","family":"Butler","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Medicine, Stony Brook University, Stony Brook, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles J.","family":"Davidson","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William F.","family":"Fearon","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjiv J.","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5123-7129","authenticated-orcid":false,"given":"John E. 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