A NEW study has revealed that heart failure with preserved ejection fraction (HFpEF) prevalence is strikingly high among patients with ischaemia and non-obstructive coronary arteries (INOCA), underscoring a critical gap in cardiovascular diagnosis and management.
HFpEF remains a complex and often underdiagnosed condition, characterised by typical heart failure symptoms despite a normal ejection fraction. Meanwhile, INOCA, frequently linked to coronary microvascular dysfunction, has emerged as an important but under-recognised cause of myocardial ischaemia, particularly among females. The overlap between these two conditions has remained poorly defined – until now.
High HFpEF Prevalence Signals Overlooked Disease Burden
In this prospective study, researchers evaluated 85 patients with INOCA who underwent comprehensive coronary function testing alongside transthoracic echocardiography. The cohort had a median age of 66 years, with females comprising 64.71% of participants.
Notably, the HFpEF prevalence in this group reached 35.29%, meaning over one-third of patients met established diagnostic criteria. This finding highlighted a substantial burden of previously unrecognised heart failure within this population.
Coronary dysfunction was widespread, with 94.12% of patients demonstrating abnormal responses to acetylcholine testing. The most common abnormality was a combination of endothelial dysfunction and coronary artery spasm, observed in 80% of participants. These findings reinforced the role of microvascular disease as a shared underlying mechanism linking INOCA and HFpEF.
Implications for Screening and Personalised Care
The study suggested that routine assessment of HFpEF prevalence in patients with INOCA could significantly alter clinical pathways. Early identification may enable clinicians to initiate guideline-directed therapies sooner, potentially improving symptoms and long-term outcomes.
Importantly, the authors emphasised that non-invasive screening tools, such as echocardiography, could be readily incorporated into standard diagnostic workflows for patients presenting with INOCA.
However, the study was limited by its relatively small sample size and single-cohort design, meaning broader validation is required. Larger studies will be essential to confirm these findings and determine how best to integrate HFpEF screening into routine care.
Overall, the results highlighted a crucial opportunity for more personalised cardiovascular management.
Reference
Stapor M et al. Prevalence of heart failure with preserved ejection fraction in patients with ischemia and non-obstructive coronary arteries. Sci Rep. 2026;DOI:10.1038/s41598-026-42032-x.
Featured image: New Africa on Adobe Stock
