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Background  Phase contrast ( PC ) cine‐magnetic resonance imaging ( MRI ) of the coronary sinus allows for noninvasive evaluation of coronary flow reserve ( CFR ), which is an index of left ventricular microvascular function. The objective of this study was to investigate coronary flow reserve in patients with heart failure with preserved ejection fraction ( HF p EF ).    Methods and Results  We studied 25 patients with  HF p EF  (mean and SD of age: 73±7 years), 13 with hypertensive left ventricular hypertrophy ( LVH ) (67±10 years), and 18 controls (65±15 years). Breath‐hold  PC  cine‐ MRI  images of the coronary sinus were obtained to assess blood flow at rest and during  ATP  infusion.  CFR  was calculated as coronary sinus blood flow during  ATP  infusion divided by coronary sinus blood flow at rest. Impairment of  CFR  was defined as  CFR  <2.5 according to a previous study. The majority (76%) of  HF p EF  patients had decreased  CFR .  CFR  was significantly decreased in  HF p EF  patients in comparison to hypertensive  LVH  patients and control subjects ( CFR : 2.21±0.55 in  HF p EF  vs 3.05±0.74 in hypertensive  LVH , 3.83±0.73 in controls;  P <0.001 by 1‐way  ANOVA ). According to multivariable linear regression analysis,  CFR  independently and significantly correlated with serum brain natriuretic peptide level (β=−68.0; 95% CI, −116.2 to −19.7;  P =0.007).    Conclusions   CFR  was significantly lower in patients with  HF p EF  than in hypertensive  LVH  patients and controls. These results indicated that impairment of  CFR  might be a pathophysiological factor for  HF p EF  and might be related to  HF p EF  disease severity.

journal of the american heart association

Impairment of Coronary Flow Reserve Evaluated by Phase Contrast Cine‐Magnetic Resonance Imaging in Patients With Heart Failure With Preserved Ejection Fraction