Coronary Flow Reserve, Inflammation, and Myocardial Strain: The CIRT-CFR Trial

Abstract

Inflammation is a key determinant of cardiovascular outcomes, but its role in heart failure is uncertain. In patients with cardiometabolic disease enrolled in the prospective, multicenter ancillary study of CIRT (Cardiovascular Inflammation Reduction Trial), CIRT-CFR (Coronary Flow Reserve to Assess Cardiovascular Inflammation), impaired coronary flow reserve was independently associated with increased inflammation and myocardial strain despite well-controlled lipid, glycemic, and hemodynamic profiles. Inflammation modified the relationship between CFR and myocardial strain, disrupting the association between cardiac blood flow and function. Future studies are needed to investigate whether an early inflammation-mediated reduction in CFR capturing microvascular ischemia may lead to heart failure in patients with cardiometabolic disease. (Cardiovascular Inflammation Reduction Trial [CIRT]; NCT01594333; Coronary Flow Reserve to Assess Cardiovascular Inflammation [CIRT-CFR]; NCT02786134).

Keywords: BMI, body mass index; CAD, coronary artery disease; CFR, coronary flow reserve; CT, computed tomography; GLS, global longitudinal strain; HDL, high-density lipoprotein cholesterol; HFpEF, heart failure with preserved ejection fraction; IL, interleukin; LDL, low-density lipoprotein cholesterol; LDM, low-dose methotrexate; LVEF, left ventricular ejection fraction; MBF, myocardial blood flow; MI, myocardial infarction; NHLBI, National Heart, Lung, and Blood Institute; NT-proBNP, N-terminal pro–B-type natriuretic peptide; PET, positron emission tomography; cardiometabolic disease; cardiovascular trial coronary flow reserve; coronary microvascular dysfunction; heart failure; hsCRP, high-sensitivity C-reactive protein; hsTNT, high-sensitivity troponin T; inflammation.