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

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).
Competing Interests: This research was supported by National Institutes of Health (NIH) R01HL132021 (to Drs Di Carli and Taqueti) and K23HL135438 (to Dr Taqueti). Dr Shah was supported by NIH R01HL135008, R01HL143224, R01HL150342, R01HL14818, and K24HL152008. Dr Libby was supported by R01HL134892. Dr Shah has received research support from Novartis; and consulting fees from Philips Ultrasound and Edwards Lifesciences. Dr Dorbala has received research support from Pfizer, GE Healthcare, and Attralus; and consulting honoraria from Pfizer and GE Healthcare. Dr Chow holds the Saul and Edna Goldfarb Chair in Cardiac Imaging Research; has received research support from TD Bank, AusculSciences, Siemens Healthineers, and Artrya; and has equity interest in General Electric. Dr Hage has received grant support from GE Healthcare, Novartis, and Idorsia Pharmaceuticals. Dr Beanlands holds the Chair in Cardiology at the University of Ottawa Heart Institute; is a University of Ottawa Distinguished Research Chair in Cardiovascular Imaging; and is a consultant for and has received grant funding from GE Healthcare, Lantheus Medical Imaging, and Jubilant DraxImage. Dr Libby is an unpaid consultant to or involved in clinical trials for Amgen, AstraZeneca, Baim Institute, Beren Therapeutics, Esperion Therapeutics, Genentech, Kancera, Kowa Pharmaceuticals, Medimmune, Merck, Norvo Nordisk, Novartis, Pfizer, Sanofi-Regeneron; is on the Scientific Advisory Board for Amgen, Caristo, Cartesian, Corvidia Therapeutics, CSL Behring, DalCor Pharmaceuticals, Dewpoint, Kowa Pharmaceuticals, Olatec Therapeutics, Medimmune, Novartis, PlaqueTec, and XBiotech, Inc; is on the Board of Directors and has a financial interest in XBiotech, Inc; and has received research funding from Novartis, the American Heart Association, the RRM Charitable Fund, and the Simard Fund. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(© 2022 Published by Elsevier on behalf of the American College of Cardiology Foundation.)