Elucidating the link between CMD and HFpEF
Research type
Research Study
Full title
Elucidating the pathophysiological link between coronary microvascular dysfunction and heart failure with preserved ejection fraction.
IRAS ID
327243
Contact name
Divaka Perera
Contact email
Sponsor organisation
King's College London
Duration of Study in the UK
2 years, 6 months, 29 days
Research summary
Heart Failure is a burdensome condition characterised by the heart’s inability to maintain adequate blood flow throughout the body and commonly manifests as profound exertional breathlessness. It is categorised by ‘ejection fraction’, a measure of how much blood is ‘ejected’ by the left ventricle when it contracts and is broadly split into heart failure with reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF). There have been numerous innovations in the treatment of the latter that has markedly improved the quality of life and prognosis for sufferers; conversely, few treatments are effective in HFpEF. Whilst speculative, this may be due to contemporary trials employing a ‘one-size-fits-all’ approach to a complex and likely multi-faceted condition. One such facet may be coronary microvascular dysfunction (CMD), an under-diagnosed condition characterised by the inability of the small arteries of the heart to augment blood flow to demand. Prior research has identified that CMD is prevalent among HFpEF sufferers. However, it is unclear whether CMD is a causative factor or simply a by-product of ‘stiff’ heart muscle observed in HFpEF. Subsequently, our study aims to elucidate the association between these two conditions by comparing how sufferers with HFpEF and CMD differ from those with sole HFpEF, of which we hypothesise that the difference will be distinct. Participants with a high likelihood of HFpEF will be recruited into a multi-stage study taking place over approximately 9 weeks; they will undergo a detailed assessment of their hearts at rest and on exercise, both invasively in the cardiac catheter lab as well as non-invasively with a cardiac MRI scan. Differences in response to exercise and commonly prescribed angina treatment will be compared between participants with and without CMD. Our study will clarify whether CMD has implications for HFpEF sufferers and may pave the way for larger clinical trials.
REC name
London - Hampstead Research Ethics Committee
REC reference
25/LO/0146
Date of REC Opinion
3 Mar 2025
REC opinion
Further Information Favourable Opinion