Evidence mapPaperPMID 40912891Full record

ArticleOpen heart2025

Prevalence and importance of coronary microvascular dysfunction in patients with heart failure and reduced or mildly reduced ejection fraction.

Charlotte Nordberg Backelin, Sara Svedlund, Entela Bollano, Clara Hjalmarsson, Akash Kumar Gupta, Karl Johan Dahllöf, Fredrik Wolfhagen Sand, Maria Lagerström Fermer, Erik Michaelsson, Alastair Moss and 6 more

Abstract read
In one paragraph

Article in Open heart, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Simple risk stratification for a complex coronary phenotype: association of the ACEF score with coronary slow flow.Postepy w kardiologii interwencyjnej = Advances in interventional cardiology · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Charlotte Nordberg BackelinCardiology Department, Sahlgrenska University Hospital, Gothenburg, Sweden charlotte.backelin@vgregion.se.ORCID http://orcid.org/0009-0009-2135-2578
Sara SvedlundDepartment of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Entela BollanoCardiology Department, Sahlgrenska University Hospital, Gothenburg, Sweden.
Clara HjalmarssonCardiology Department, Sahlgrenska University Hospital, Gothenburg, Sweden.
Akash Kumar GuptaBiometrics, BioPharmaceuticals R&D, AstraZeneca India Private Limited, Bengaluru, Karnataka, India.
Karl Johan DahllöfBiometrics, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.
Fredrik Wolfhagen SandClinical Operations, Early Cardiovascular, Renal & Metabolism, AstraZeneca, Gothenburg, Sweden.
Maria Lagerström FermerTranslational Science & Clinical Development, Early Cardiovascular, Renal & Metabolism, AstraZeneca, Gothenburg, Sweden.
Erik MichaelssonTranslational Science & Clinical Development, Early Cardiovascular, Renal & Metabolism, AstraZeneca, Gothenburg, Sweden.
Alastair MossTranslational Science & Clinical Development, Early Cardiovascular, Renal & Metabolism, AstraZeneca, Cambridge, UK.ORCID http://orcid.org/0000-0003-4123-2070
Ida SilfversparreCardiology Department, Sahlgrenska University Hospital, Gothenburg, Sweden.
Tove BrodinDepartment of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Carlo PirazziCardiology Department, Sahlgrenska University Hospital, Gothenburg, Sweden.
Lars LundDepartment of Medicine, Karolinska Institute, Stockholm, Sweden.
Camilla HageDepartment of Medicine, Karolinska Institute, Stockholm, Sweden.ORCID http://orcid.org/0000-0002-4142-2416
Charlotta LjungmanCardiology Department, Sahlgrenska University Hospital, Gothenburg, Sweden.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsWe 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).

methodPatients with stable, symptomatic heart failure with left ventricular ejection fraction (LVEF) <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 <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.

resultsA total of 125 patients were included, of whom 99 (79%) were men. The overall mean age is 73.4 (±7.5) 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<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.

conclusionCMD 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.

Indexed as

Coronary CirculationCoronary VesselsHeart FailureMicrocirculationMicrovesselsStroke VolumeVentricular Function, LeftAgedAged, 80 and overBiomarkersEchocardiography, DopplerFemaleHumansMaleMiddle AgedPrevalenceBiomarkersCoronary VesselsEchocardiographyEpidemiologyHeart Failure, Systolic

Identifiers

PMID40912891
PMCPMC12414198

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.