Exploring links between inflammation and HFpEF

Dr. Roshanak Markley

People live with and die of heart failure every day — as many as half with preserved left ventricular ejection fraction (HFpEF). Conventional treatments for heart failure with reduced ejection fraction remain less effective for individuals with HFpEF.

This suggests that there is a missing link in the mechanism and understanding pathophysiology of HFpEF. A new study seeks to explore the role
of inflammation and microvascular disease in pathogenesis of HFpEF using a novel cardiac MRI quantitative myocardial perfusion mapping.

Possibly due to comorbidities like diabetes and obesity, data shows that HFpEF patients have higher inflammation in their blood streams. Dr. Roshanak Markley, assistant professor of medicine in internal medicine and radiology at VCU Health, believes that’s no coincidence. A new 18-month study led by Markley uses a novel perfusion technique and MRI to explore possible links between inflammation, microvascular disease and HFpEF.

According to Markley, previous research using phase contrast cinemagnetic resonance imaging (cMRI) of coronary sinus blood flow during stress shows that coronary flow reserve is significantly lower in patients with HFpEF. Her new study, “Inflammation and Microvascular Dysfunction in Patients with Heart Failure with Preserved Ejection Fraction: Exploration of a Potential Missing Link Using Cardiac MRI,” examines the relationship between inflammation and microvascular disease using a novel cMRI perfusion technique that can quantify myocardial blood flow and create an automated pixel-wise perfusion map of the heart to diagnose microvascular disease.

“If we can find a link and identify these high-risk patients with inflammation and microvascular disease, then we can create therapies to target inflammation, restore microvascular blood flow, and hopefully improve their exercise tolerance and quality of life,” she said.

The hypothesis of Markley’s study suggests that inflammation induces coronary microvascular disease (CMD), leading to impairment of diastolic function and exercise capacity. Markley explores the strength of correlation between CMD, diastolic impairment and inflammatory biomarkers. Recruited from referrals across VCU Health, the study includes 20 men and women but aims to key in on a prevalence for HFpEF among females. By administering adenosine and increasing blood flow in the heart, the researchers image the perfusion in the heart using a novel sequence that can calculate the myocardial blood flow and create a perfusion map for more accurate assessment of blood flow. Subjects will also undergo an echocardiogram to assess for impairment in diastolic function and laboratory assessment of inflammation in the blood.