Prevalence of heart failure with preserved ejection fraction in patients with ischemia and non-obstructive coronary arteries

Coronary microvascular disease is a key factor in the pathogenesis of ischemia with non-obstructive coronary arteries (INOCA) and heart failure with preserved ejection fraction (HFpEF). However, the occurrence of HFpEF in INOCA patients remains poorly understood. This study aimed to evaluate the prevalence of HFpEF in INOCA patients.We prospectively enrolled consecutive INOCA patients who underwent comprehensive coronary function assessments and transthoracic echocardiography. HFpEF was diagnosed according to European Society of Cardiology criteria. The study was registered at ClinicalTrials.gov (NCT05313919). We prospectively enrolled consecutive INOCA patients who underwent comprehensive coronary function assessments and transthoracic echocardiography. HFpEF was diagnosed according to European Society of Cardiology criteria. The study was registered at ClinicalTrials.gov (NCT05313919). We evaluated a total of 85 INOCA patients, of whom 64.71% (55) were women, with a median age of 66 years (IQR 59–71). An abnormal response to acetylcholine, defined as endothelial dysfunction and/or inducible vasospasm, was observed in 94.12% (80) of the group, with the most common finding being concurrent endothelial dysfunction and coronary artery spasm, affecting 80% (68) of subjects. Notably, HFpEF was diagnosed in 35.29% (30) of patients. HFpEF is common among patients with INOCA. These results support routine noninvasive HFpEF screening as part of the initial diagnostic evaluation. Early recognition may identify a large subgroup eligible for guideline-directed HFpEF therapies, enabling more personalized management and potentially improving outcomes.